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Individual
MARY GREEN
Active
Individual
MARY GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, IBCLC
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
R082649
MD
163WL0100X
Lactation Consultant (Registered Nurse)
R082649
MD
Other
Enumeration date
04/22/2020
Last updated
06/04/2020
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