Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | L13899 | NC |
NPI | 1164936175 |
---|---|
Provider Name | Rebecca Costello |
First Address | Chapel Hill, NC 27514-2656 |
Second Address | Chapel Hill, NC 27514-2656 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2017 |
Last Update Date | 29/11/2017 |