Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | L-146175 |
NPI | 1083214357 |
---|---|
Provider Name | Laci Ann Tang |
First Address | Fairfax, VA 22032-3409 |
Second Address | Fairfax, VA 22032-3409 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2020 |
Last Update Date | 27/10/2020 |