Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | L-86497 | SC |
NPI | 1205209541 |
---|---|
Provider Name | Mara Irene Lubic |
First Address | Chesapeake, VA 23323-6306 |
Second Address | Chesapeake, VA 23323-6306 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2015 |
Last Update Date | 14/01/2022 |