Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | 11093949 | TX |
NPI | 1104263383 |
---|---|
Provider Name | Mrs. Courtney White |
First Address | Coppell, TX 75019-5736 |
Second Address | Coppell, TX 75019-4033 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2013 |
Last Update Date | 29/05/2013 |