Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | NY |
NPI | 1104175066 |
---|---|
Provider Name | Jeanne Rosser |
First Address | Riverhead, NY 11901-4454 |
Second Address | Riverhead, NY 11901-4454 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2012 |
Last Update Date | 06/09/2012 |