Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant |
NPI | 1326477548 |
---|---|
Provider Name | Ms. Stephanie Amber Rodriguez |
First Address | Brainerd, MN 56401-5902 |
Second Address | Brainerd, MN 56401-5902 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2013 |
Last Update Date | 07/11/2013 |