Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | L-21945 | TX |
NPI | 1023673829 |
---|---|
Provider Name | Tiphany Illyes |
First Address | League City, TX 77573-1971 |
Second Address | League City, TX 77573-1971 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2019 |
Last Update Date | 07/05/2019 |