Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | 11111671 | UT |
NPI | 1073964698 |
---|---|
Provider Name | Meghan Reed |
First Address | Park City, UT 84098-5212 |
Second Address | Park City, UT 84098-5212 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2016 |
Last Update Date | 24/06/2016 |