Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 174N00000X | Lactation Consultant |
NPI | 1073172367 |
---|---|
Provider Name | Kelli Nicole Brien |
First Address | South Bend, IN 46680-2648 |
Second Address | South Bend, IN 46614-1113 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2019 |
Last Update Date | 29/09/2019 |