Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | 11099970 | WA |
NPI | 1063715084 |
---|---|
Provider Name | Tanisha Renee Grice |
First Address | Bainbridge Island, WA 98110-1148 |
Second Address | Bainbridge Island, WA 98110-1148 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2010 |
Last Update Date | 08/04/2011 |