Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | L-98381 | WI |
NPI | 1184395923 |
---|---|
Provider Name | Mrs. Jennifer Anne Fell |
First Address | Burlington, WI 53105-7604 |
Second Address | Brookfield, WI 53005-4630 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2021 |
Last Update Date | 22/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
L-98381 | IBCLC (01) | WI |