Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | 19210911 | VA |
NPI | 1194120469 |
---|---|
Provider Name | Mrs. Sharon Ann Gough |
First Address | Nokesville, VA 20181-2921 |
Second Address | Nokesville, VA 20181-2921 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/10/2014 |
Last Update Date | 29/10/2014 |