Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 174N00000X | Lactation Consultant | 305208 | NY |
NPI | 1053995605 |
---|---|
Provider Name | Shelly Wierman |
First Address | Croton On Hudson, NY 10520-3536 |
Second Address | Croton On Hudson, NY 10520-3536 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2021 |
Last Update Date | 10/05/2021 |