Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | L-82781 |
NPI | 1093172017 |
---|---|
Provider Name | Marie Sproat |
First Address | Camp Lejeune, NC 28547-1313 |
Second Address | Jacksonville, NC 28540-5916 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/01/2016 |
Last Update Date | 21/01/2016 |