Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | 79127 | SC |
NPI | 1255733432 |
---|---|
Provider Name | Meredith Wentzel |
First Address | Simpsonville, SC 29681-6588 |
Second Address | Greenville, SC 29615-4610 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2014 |
Last Update Date | 17/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1255733432 | (05) | SC |