Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | 19915357 |
NPI | 1205188331 |
---|---|
Provider Name | Kelley Baer |
First Address | Los Alamos, NM 87544-2429 |
Second Address | Los Alamos, NM 87544-2429 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2012 |
Last Update Date | 13/10/2012 |