Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | 328496 | NE |
NPI | 1083201107 |
---|---|
Provider Name | Stephanie C Bradley |
First Address | Omaha, NE 68104-2505 |
Second Address | Omaha, NE 68104-2505 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2020 |
Last Update Date | 22/12/2020 |