Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 174N00000X | Lactation Consultant |
NPI | 1053737742 |
---|---|
Provider Name | Taerynn Graham |
First Address | Kokomo, IN 46902-3636 |
Second Address | Kokomo, IN 46902-3636 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2014 |
Last Update Date | 05/03/2014 |