Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | CA |
NPI | 1023506193 |
---|---|
Provider Name | Michelle Meredith Clookie |
First Address | San Diego, CA 92103-5703 |
Second Address | San Diego, CA 92109-8032 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2018 |
Last Update Date | 24/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
NONE | NO OTHER NUMBERS (01) | CA |