Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | 38429 | MA |
NPI | 1104293521 |
---|---|
Provider Name | Ms. Elizabeth Libby |
First Address | Brewster, MA 02631-2452 |
Second Address | Brewster, MA 02631-2452 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2015 |
Last Update Date | 02/09/2015 |