Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 174N00000X | Lactation Consultant | L-152624 | |
Y | 176B00000X | Midwife | 164-49 | WI |
NPI | 1326575986 |
---|---|
Provider Name | Kristy Hinz |
First Address | Richmond, IL 60071-9404 |
Second Address | Spring Grove, IL 60081-9688 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2017 |
Last Update Date | 12/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1326575986 | (05) | WI |