Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | 18910401 | VA |
NPI | 1184973372 |
---|---|
Provider Name | Mrs. Nancy Jean Clark |
First Address | Springfield, VA 22153-1701 |
Second Address | Springfield, VA 22153-1701 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/09/2012 |
Last Update Date | 03/09/2012 |