Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | ALPP-205479 | RI |
NPI | 1073922068 |
---|---|
Provider Name | Mrs. Holly Wiseman |
First Address | Clinton Township, MI 48035-1688 |
Second Address | Clinton Township, MI 48035-1688 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2014 |
Last Update Date | 05/08/2014 |