Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant |
NPI | 1053797159 |
---|---|
Provider Name | Maya Radoccia-Kennen |
First Address | Clarkdale, AZ 86324-0225 |
Second Address | Clarkdale, AZ 86324 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2015 |
Last Update Date | 31/07/2015 |