Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 174N00000X | Lactation Consultant | L-41918 |
NPI | 1174827893 |
---|---|
Provider Name | Mrs. Kimberly Elaine Connor |
First Address | Morgantown, WV 26505-1876 |
Second Address | Triadelphia, WV 26059-1154 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2011 |
Last Update Date | 04/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
018811 | (05) | OH |
1174827893 | (05) | WV |