Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | 19411880 | GA |
NPI | 1184905200 |
---|---|
Provider Name | Mrs. Pamela Diane Holland |
First Address | Pooler, GA 31322-3958 |
Second Address | Pooler, GA 31322-3958 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2011 |
Last Update Date | 02/09/2011 |