Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | 21442-31 | WI |
NPI | 1104193846 |
---|---|
Provider Name | Mrs. Beth Marie Eddy |
First Address | Hales Corners, WI 53130-1810 |
Second Address | Hales Corners, WI 53130-1810 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/11/2011 |
Last Update Date | 23/11/2011 |