Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 174N00000X | Lactation Consultant |
NPI | 1245591528 |
---|---|
Provider Name | Mrs. Nancy W. Derr |
First Address | Statesboro, GA 30458-9199 |
Second Address | Statesboro, GA 30458-9199 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2012 |
Last Update Date | 04/06/2012 |