Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | KY |
NPI | 1053840710 |
---|---|
Provider Name | Mary Oliver Humke |
First Address | Louisville, KY 40206-2309 |
Second Address | Louisville, KY 40206 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2017 |
Last Update Date | 07/06/2017 |