Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant |
NPI | 1144514407 |
---|---|
Provider Name | Mrs. Phyllis Goodwin Merrill |
First Address | Parkton, MD 21120-9110 |
Second Address | Parkton, MD 21120-9110 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2011 |
Last Update Date | 04/06/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
190-10574 | INTERNATIONAL BOARD OF LACTATION CONSULTANT EXAMINERS (IBLCE) (01) |