Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | 48393 | IN |
NPI | 1063037414 |
---|---|
Provider Name | Gemma Regan |
First Address | Notre Dame, IN 46556-4704 |
Second Address | South Bend, IN 46637-6028 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2020 |
Last Update Date | 11/06/2020 |