Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | L-150024 |
NPI | 1255805875 |
---|---|
Provider Name | Michelle Ruby Anthonio |
First Address | Dallas, TX 75231-7337 |
Second Address | Dallas, TX 75231-7337 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2019 |
Last Update Date | 16/01/2019 |