Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | L-125076 | NE |
NPI | 1366073587 |
---|---|
Provider Name | Mrs. Victoria Natalie Casillas |
First Address | Scottsbluff, NE 69361-7004 |
Second Address | Scottsbluff, NE 69361-7004 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2020 |
Last Update Date | 27/01/2020 |