Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant |
NPI | 1104374909 |
---|---|
Provider Name | Sally Hart Nelson |
First Address | Uintah, UT 84403-5491 |
Second Address | Salt Lake City, UT 84102-2098 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2016 |
Last Update Date | 21/09/2016 |