Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | L-113871 | FL |
NPI | 1275024309 |
---|---|
Provider Name | Ms. Amy Walker Johnston |
First Address | Fernandina Beach, FL 32034-5409 |
Second Address | Fernandina Beach, FL 32034-4719 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2018 |
Last Update Date | 24/05/2018 |