Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | 11295806 |
NPI | 1063711422 |
---|---|
Provider Name | Katherine Rose Mac |
First Address | Carbondale, CO 81623-8792 |
Second Address | Carbondale, CO 81623-8792 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2011 |
Last Update Date | 25/04/2013 |