Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 174N00000X | Lactation Consultant | ||
Y | 176B00000X | Midwife |
NPI | 1184015265 |
---|---|
Provider Name | Samantha Maddox |
First Address | Grand Prairie, TX 75050-2314 |
Second Address | Grand Prairie, TX 75050-2314 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/02/2015 |
Last Update Date | 14/09/2021 |