Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | 11162380 | MI |
NPI | 1235486077 |
---|---|
Provider Name | Mrs. Marta Elizabeth Lundquist-Shaw |
First Address | Fenton, MI 48430-9599 |
Second Address | Fenton, MI 48430-9599 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2012 |
Last Update Date | 10/08/2012 |