Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant |
NPI | 1336732668 |
---|---|
Provider Name | Ms. Carolyn Ericson |
First Address | Arlington, VA 22206-1920 |
Second Address | Arlington, VA 22206-1920 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/02/2021 |
Last Update Date | 17/02/2021 |