Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | NY |
NPI | 1346533288 |
---|---|
Provider Name | Mrs. Shanna Jesch |
First Address | Brooktondale, NY 14817-9513 |
Second Address | Brooktondale, NY 14817-9513 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2011 |
Last Update Date | 25/05/2011 |