Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | L-69485 | NJ |
NPI | 1144693078 |
---|---|
Provider Name | Katharine Fresso |
First Address | Sparta, NJ 07871-2104 |
Second Address | Sparta, NJ 07871-2104 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/10/2015 |
Last Update Date | 30/10/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
L-69485 | IBLCE (01) | NJ |