Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant |
NPI | 1053513671 |
---|---|
Provider Name | Patricia A Bucknell |
First Address | Avon Lake, OH 44012-1534 |
Second Address | Avon Lake, OH 44012-1534 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2007 |
Last Update Date | 30/04/2011 |