Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | L-72574 |
NPI | 1053980631 |
---|---|
Provider Name | Jennifer Black |
First Address | Lexington, SC 29073-8185 |
Second Address | Columbia, SC 29201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2021 |
Last Update Date | 04/07/2021 |