Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant |
NPI | 1376985598 |
---|---|
Provider Name | Susan Nelson |
First Address | Austin, TX 78750-8322 |
Second Address | Austin, TX 78750-8322 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2013 |
Last Update Date | 29/07/2013 |