Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 174N00000X | Lactation Consultant | 207105 | PA |
NPI | 1356715056 |
---|---|
Provider Name | Mrs. Nicola Jayne Wray |
First Address | Alexandria, VA 22314-1676 |
Second Address | Alexandria, VA 22314-1676 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2015 |
Last Update Date | 18/11/2015 |