Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | 10945079 | NC |
NPI | 1174878680 |
---|---|
Provider Name | Mrs. Kenyatta Elliott |
First Address | Fayetteville, NC 28304-3424 |
Second Address | Fayetteville, NC 28304-3424 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2012 |
Last Update Date | 20/07/2012 |