Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | 11010140 | VA |
NPI | 1295000115 |
---|---|
Provider Name | Mrs. Denise M Wall |
First Address | Palmyra, VA 22963-4904 |
Second Address | Palmyra, VA 22963-4904 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2012 |
Last Update Date | 09/03/2012 |