Individual
AUTUMN WAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6581 IRONBOUND BAY AVE, LAS VEGAS, NV 89139-6130
(904) 613-8255
Mailing address
6581 IRONBOUND BAY AVE, LAS VEGAS, NV 89139-6130
(904) 613-8255
Taxonomy
Speciality
Code
Description
License number
State
163WL0100X
Lactation Consultant (Registered Nurse)
Primary
RN56095
NV
Other
Enumeration date
04/11/2017
Last updated
04/11/2017
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