Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant |
NPI | 1114303914 |
---|---|
Provider Name | Jennifer Bradley |
First Address | Cabot, AR 72023-7733 |
Second Address | Cabot, AR 72023-7733 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2015 |
Last Update Date | 04/08/2015 |