Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 174N00000X | Lactation Consultant | ||
Y | 174N00000X | Lactation Consultant | L-136065 |
NPI | 1194222414 |
---|---|
Provider Name | Stacie Banks |
First Address | Rio Rancho, NM 87124-8856 |
Second Address | Rio Rancho, NM 87124-8856 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2018 |
Last Update Date | 12/04/2018 |