Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 174N00000X | Lactation Consultant | L-22092 | FL |
NPI | 1174808695 |
---|---|
Provider Name | Laene M Keith |
First Address | Viera, FL 32955-6704 |
Second Address | Viera, FL 32955-6704 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2011 |
Last Update Date | 29/12/2021 |