Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | 253746 | IL |
NPI | 1114492212 |
---|---|
Provider Name | Ms. Ashley Elizabeth Heatherly |
First Address | Orange, TX 77632-6547 |
Second Address | Orange, TX 77632-6547 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2018 |
Last Update Date | 04/10/2018 |