Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | L-159665 |
NPI | 1083130728 |
---|---|
Provider Name | Ms. Lydia Heeeun Doublestein |
First Address | Fort Collins, CO 80521-4344 |
Second Address | Fort Collins, CO 80521-4344 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2017 |
Last Update Date | 08/09/2021 |