Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant |
NPI | 1205185162 |
---|---|
Provider Name | Mellanie Sheppard |
First Address | Hurst, TX 76053-4393 |
Second Address | Hurst, TX 76053-4393 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2012 |
Last Update Date | 06/09/2012 |