Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant |
NPI | 1184165771 |
---|---|
Provider Name | Ms. Michana Shaner |
First Address | Waldorf, MD 20603-6057 |
Second Address | Waldorf, MD 20603-6057 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2017 |
Last Update Date | 15/03/2017 |