Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | 11280975 | MN |
NPI | 1285988337 |
---|---|
Provider Name | Leah A Jacobson |
First Address | Ironton, MN 56455-0238 |
Second Address | Ironton, MN 56455-1001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2012 |
Last Update Date | 27/10/2012 |