Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | L-107778 |
NPI | 1295329332 |
---|---|
Provider Name | Shannon Gaydeski |
First Address | Jacksonville, NC 28540-4756 |
Second Address | Jacksonville, NC 28540-4756 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2021 |
Last Update Date | 01/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00000000 | N/A (01) |