Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 174N00000X | Lactation Consultant | ||
N | 175M00000X | Lay Midwife | ||
N | 225700000X | Massage Therapist |
NPI | 1063170165 |
---|---|
Provider Name | Valencia Latrice Potts |
First Address | Lansing, IL 60438-2326 |
Second Address | Lansing, IL 60438-2326 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2021 |
Last Update Date | 06/12/2021 |