Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant |
NPI | 1164007993 |
---|---|
Provider Name | Mrs. Ericka L Moore |
First Address | Grand Island, FL 32735-9019 |
Second Address | Grand Island, FL 32735-9019 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/03/2021 |
Last Update Date | 21/08/2021 |