Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 174N00000X | Lactation Consultant |
NPI | 1285277376 |
---|---|
Provider Name | Stephanie Renea Dawson |
First Address | Lakeland, FL 33810-8204 |
Second Address | Lakeland, FL 33805-1980 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/10/2019 |
Last Update Date | 21/04/2020 |