Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | L-104476 | AR |
NPI | 1215408471 |
---|---|
Provider Name | Michelle R Mansker |
First Address | Bentonville, AR 72712-5313 |
Second Address | Bentonville, AR 72712-5313 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/12/2018 |
Last Update Date | 16/12/2018 |