Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant |
NPI | 1275163750 |
---|---|
Provider Name | Madolynn Jon Duckwall |
First Address | Burnsville, MN 55337-2709 |
Second Address | Burnsville, MN 55337-2709 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2020 |
Last Update Date | 23/01/2020 |