Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | L-75562 | AL |
NPI | 1295181741 |
---|---|
Provider Name | Jenny Mizzell |
First Address | Birmingham, AL 35213-2103 |
Second Address | Birmingham, AL 35213-2103 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2016 |
Last Update Date | 13/05/2016 |