Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | L-303124 | NC |
NPI | 1174118863 |
---|---|
Provider Name | Tiffany Slade |
First Address | Reidsville, NC 27320-7752 |
Second Address | Reidsville, NC 27320-7752 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/03/2021 |
Last Update Date | 22/07/2021 |