Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant |
NPI | 1053663054 |
---|---|
Provider Name | Lois Karleen Acosta |
First Address | Prescott, AZ 86305-3700 |
Second Address | Prescott, AZ 86305-3700 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/10/2012 |
Last Update Date | 15/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
11193258 | IBCLC (01) | AZ |