Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | L-302155 |
NPI | 1104407360 |
---|---|
Provider Name | Jaci Lee Mccaskell Kulish |
First Address | Moorhead, MN 56560-5864 |
Second Address | Moorhead, MN 56560-5864 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2021 |
Last Update Date | 19/04/2021 |