Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 174N00000X | Lactation Consultant |
NPI | 1316572845 |
---|---|
Provider Name | Nia Mathis |
First Address | Killeen, TX 76542-6201 |
Second Address | Killeen, TX 76542-6201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/03/2020 |
Last Update Date | 04/03/2020 |