Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | ALPP28107 | MA |
NPI | 1013313790 |
---|---|
Provider Name | Mrs. Virginia Jones Martin |
First Address | Livermore, CO 80536-8762 |
Second Address | Livermore, CO 80536-8762 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2014 |
Last Update Date | 07/11/2014 |