Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | 11111419 | PA |
NPI | 1033506951 |
---|---|
Provider Name | Victoria Sullivan |
First Address | Reading, PA 19606-2881 |
Second Address | Reading, PA 19606-2881 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2015 |
Last Update Date | 17/04/2015 |