Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | 208839 | IL |
NPI | 1154859965 |
---|---|
Provider Name | Mrs. Kadie Marie Tannehill |
First Address | Saint Peters, MO 63376-3704 |
Second Address | Saint Charles, MO 63303-5607 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2017 |
Last Update Date | 24/05/2017 |