Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 174N00000X | Lactation Consultant | 472020364 | MT |
NPI | 1235534421 |
---|---|
Provider Name | Marisa Wright |
First Address | Missoula, MT 59801-5427 |
Second Address | Missoula, MT 59801-5427 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/10/2014 |
Last Update Date | 31/10/2014 |