Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant |
NPI | 1366074809 |
---|---|
Provider Name | Medora Jean Hamrick |
First Address | Fate, TX 75087-0228 |
Second Address | Fate, TX 75087-0228 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/02/2020 |
Last Update Date | 11/02/2020 |