Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | L-302748 | IN |
NPI | 1194499467 |
---|---|
Provider Name | Randi Veronica Davis |
First Address | Walkerton, IN 46574-1086 |
Second Address | Walkerton, IN 46574-1086 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2021 |
Last Update Date | 02/08/2021 |