Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | L-122572 | TX |
NPI | 1154973766 |
---|---|
Provider Name | Kelly Page |
First Address | Frisco, TX 75036-4635 |
Second Address | Frisco, TX 75036-4635 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2019 |
Last Update Date | 13/07/2019 |