Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | 10613423 | TX |
NPI | 1285920793 |
---|---|
Provider Name | Mrs. Sharon Lois Mattes |
First Address | Garland, TX 75044-7238 |
Second Address | Garland, TX 75044-7238 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2011 |
Last Update Date | 22/06/2011 |