Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | 198-14894 | IL |
NPI | 1336456037 |
---|---|
Provider Name | Jane Madaj |
First Address | Roselle, IL 60172-2955 |
Second Address | Roselle, IL 60172-2955 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2010 |
Last Update Date | 26/05/2011 |