Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | L-56572 | MI |
NPI | 1275938391 |
---|---|
Provider Name | Stacy Davis |
First Address | Detroit, MI 48205-2829 |
Second Address | Detroit, MI 48205-2829 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2014 |
Last Update Date | 31/10/2014 |