Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | 225649 | NJ |
NPI | 1053788554 |
---|---|
Provider Name | Mrs. Emily Marianne Sullivan |
First Address | Westwood, NJ 07675-3433 |
Second Address | Westwood, NJ 07675-3433 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2015 |
Last Update Date | 31/08/2015 |