Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | L-150012 | AK |
NPI | 1093278103 |
---|---|
Provider Name | Ms. Kallyn Ann Lang |
First Address | Wasilla, AK 99687-3083 |
Second Address | Wasilla, AK 99623-9962 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2019 |
Last Update Date | 08/04/2019 |