Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 174N00000X | Lactation Consultant |
NPI | 1073994570 |
---|---|
Provider Name | Jennifer E Fantasia |
First Address | Pawtucket, RI 02860-1743 |
Second Address | Greenville, RI 02828-1927 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2015 |
Last Update Date | 24/01/2022 |