Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | 55895 | NM |
NPI | 1386205672 |
---|---|
Provider Name | Holly Beck |
First Address | Santa Fe, NM 87501-1552 |
Second Address | Santa Fe, NM 87501-1552 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2019 |
Last Update Date | 26/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
55895 | LICENSE (01) | NM |