Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 174N00000X | Lactation Consultant |
NPI | 1285108548 |
---|---|
Provider Name | Roxanne Donna-Shea Bogalis |
First Address | Wimauma, FL 33598-6180 |
Second Address | Wimauma, FL 33598-6180 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2019 |
Last Update Date | 18/01/2019 |