Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 174N00000X | Lactation Consultant | 10320587 | NY |
NPI | 1225388374 |
---|---|
Provider Name | Mrs. Polly Ann Thoman |
First Address | Lancaster, NY 14086-2931 |
Second Address | Lancaster, NY 14086-2931 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/09/2012 |
Last Update Date | 02/07/2014 |