Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant |
NPI | 1356929921 |
---|---|
Provider Name | Mrs. Daniele Johnston |
First Address | Caldwell, ID 83607-7623 |
Second Address | Caldwell, ID 83607-7623 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2021 |
Last Update Date | 01/04/2021 |