Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | L-10364 | NM |
NPI | 1154856102 |
---|---|
Provider Name | Suzanne W Anderson |
First Address | Sandia Park, NM 87047-6802 |
Second Address | Sandia Park, NM 87047-6802 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2017 |
Last Update Date | 27/04/2017 |