Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 174N00000X | Lactation Consultant | AZ |
NPI | 1366072266 |
---|---|
Provider Name | Mirishka Elizabeth Gill |
First Address | Mesa, AZ 85207-8669 |
Second Address | Mesa, AZ 85207-8669 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2020 |
Last Update Date | 27/01/2020 |