Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | ALPP-42983 | NY |
NPI | 1306245808 |
---|---|
Provider Name | Miss Betsy Ann Bergmann |
First Address | Grand Island, NY 14072-3026 |
Second Address | Grand Island, NY 14072-3026 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2014 |
Last Update Date | 20/08/2014 |