Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | L-64979 | WA |
NPI | 1134591068 |
---|---|
Provider Name | Lisa Keres |
First Address | Marysville, WA 98270-4148 |
Second Address | Marysville, WA 98270-4148 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/10/2015 |
Last Update Date | 30/10/2015 |