Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | 11133184 | CA |
NPI | 1144642497 |
---|---|
Provider Name | Linda Fodrey Barnes |
First Address | Riverside, CA 92508-9324 |
Second Address | Riverside, CA 92508-9324 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2014 |
Last Update Date | 06/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
11133184 | IBCLC (01) | CA |