Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | 11011770 | OK |
NPI | 1083907091 |
---|---|
Provider Name | Ms. Carla Beth Robertson |
First Address | Poteau, OK 74953-9067 |
Second Address | Poteau, OK 74953-9067 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2011 |
Last Update Date | 24/05/2011 |