Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant |
NPI | 1225572761 |
---|---|
Provider Name | Mr. Lisa Lien |
First Address | Gresham, OR 97080-5739 |
Second Address | Gresham, OR 97080-5739 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/12/2016 |
Last Update Date | 16/12/2016 |