Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 174N00000X | Lactation Consultant |
NPI | 1124512272 |
---|---|
Provider Name | Staysha Shae Quentrill |
First Address | Winfield, WV 25213-9542 |
Second Address | Winfield, WV 25213-9542 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2018 |
Last Update Date | 21/06/2018 |