Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | L-82469 | NE |
NPI | 1326411091 |
---|---|
Provider Name | Mrs. Cortney Austin Mactaggart |
First Address | Bellevue, NE 68123-4612 |
Second Address | Bellevue, NE 68123-4612 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2015 |
Last Update Date | 03/11/2015 |