Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | L-22337 | NY |
NPI | 1073116919 |
---|---|
Provider Name | Ms. Patricia Ann Lane |
First Address | Glenmont, NY 12077-3522 |
Second Address | Glenmont, NY 12077-3522 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2020 |
Last Update Date | 20/11/2020 |