Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | L-155377 | AZ |
NPI | 1063073963 |
---|---|
Provider Name | Heather Marie Evans |
First Address | Mesa, AZ 85209-1511 |
Second Address | Mesa, AZ 85209-1511 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2019 |
Last Update Date | 22/06/2019 |