Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | 026.0009203 | VT |
NPI | 1346622479 |
---|---|
Provider Name | Nancy Clark |
First Address | West Topsham, VT 05086 |
Second Address | West Topsham, VT 05086 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2015 |
Last Update Date | 25/06/2015 |