Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | 311-78094 | ZZ |
NPI | 1164970463 |
---|---|
Provider Name | Seyedeh Maryam Madani |
First Address | Reston, VA 20191-1608 |
Second Address | Reston, VA 20191-1608 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2016 |
Last Update Date | 14/09/2016 |