Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | 240589 | OK |
NPI | 1184079709 |
---|---|
Provider Name | Melissa David |
First Address | Broken Arrow, OK 74011 |
Second Address | Broken Arrow, OK 74011 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2016 |
Last Update Date | 02/05/2016 |