Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | L31823 |
NPI | 1346634979 |
---|---|
Provider Name | Jacqueline Rouse-Johnson |
First Address | Waldorf, MD 20601-4539 |
Second Address | Waldorf, MD 20601-4539 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2015 |
Last Update Date | 20/03/2015 |