Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | 308480 | FL |
NPI | 1023672748 |
---|---|
Provider Name | Jacqueline Irene Jancek |
First Address | Lithia, FL 33547-2079 |
Second Address | Lithia, FL 33547-2079 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2019 |
Last Update Date | 29/04/2019 |