Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | L99080 | NC |
NPI | 1356875561 |
---|---|
Provider Name | Mrs. Nitaya Reyes Mackey |
First Address | Knightdale, NC 27545-5601 |
Second Address | Rocky Mount, NC 27804-2237 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2017 |
Last Update Date | 13/04/2017 |