Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | L-28104 | ZZ |
NPI | 1164835526 |
---|---|
Provider Name | Tanja Knutson |
First Address | Austin, TX 78738-5382 |
Second Address | Austin, TX 78738-5382 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2014 |
Last Update Date | 03/06/2014 |