Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant |
NPI | 1043780364 |
---|---|
Provider Name | Ms. Jennifer P Sullivan |
First Address | Poughkeepsie, NY 12603-1603 |
Second Address | Poughkeepsie, NY 12603-1603 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2018 |
Last Update Date | 29/11/2018 |