Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant |
NPI | 1316524671 |
---|---|
Provider Name | Mrs. Kelly Lynn Menne |
First Address | Sheridan, OR 97378-9767 |
Second Address | Sheridan, OR 97378-9767 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2021 |
Last Update Date | 24/03/2021 |