Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | ||
N | 175M00000X | Lay Midwife |
NPI | 1316438625 |
---|---|
Provider Name | Ms. Tamara Naomi Thompson Moore |
First Address | Oconomowoc, WI 53066-5910 |
Second Address | Madison, WI 53704-4104 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2018 |
Last Update Date | 22/05/2018 |