Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant |
NPI | 1245772441 |
---|---|
Provider Name | Lisa Broughton |
First Address | Concord, CA 94521-4406 |
Second Address | Concord, CA 94521-4406 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2016 |
Last Update Date | 06/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
L-16437 | IBCLC (01) | CA |