Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant |
NPI | 1073938783 |
---|---|
Provider Name | Kristin Glenn |
First Address | Fort Collins, CO 80524-3960 |
Second Address | Fort Collins, CO 80524-3960 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/03/2014 |
Last Update Date | 04/03/2014 |