Individual
MRS. MALLORY DAWN MUDD POMERVILLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
IBCLC, LPN
Contact information
Practice address
1538 BOWFIN CT, UNIT D, KEY WEST, FL 33040-6725
(660) 909-2350
Mailing address
1538 BOWFIN CT, UNIT D, KEY WEST, FL 33040-6725
(660) 909-2350
Taxonomy
Speciality
Code
Description
License number
State
163WL0100X
Lactation Consultant (Registered Nurse)
Primary
L-41930
FL
164W00000X
Licensed Practical Nurse
PN 5214349
FL
Other
Enumeration date
03/31/2014
Last updated
03/31/2014
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