Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | L-126587 |
NPI | 1083122964 |
---|---|
Provider Name | Mrs. Tonja Denise Carpenter |
First Address | Waco, TX 76707-2862 |
Second Address | Waco, TX 76701-1711 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/01/2018 |
Last Update Date | 13/01/2018 |