Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | L-23776 | VA |
NPI | 1336610211 |
---|---|
Provider Name | Mrs. Rebecca Kusche |
First Address | Olalla, WA 98359-9666 |
Second Address | Olalla, WA 98359-9666 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/12/2018 |
Last Update Date | 17/12/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
L-23776 | IBCLE (01) | VA |
NU60418972 | NUTRITIONIST CERTIFICATION (01) | WA |