Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | L-48935 | TX |
NPI | 1245645910 |
---|---|
Provider Name | Mrs. Kristine Keller |
First Address | Austin, TX 78749-2233 |
Second Address | Austin, TX 78749-2233 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2014 |
Last Update Date | 21/06/2014 |