Healthcare Provider Details

I. General information

NPI: 1902235252
Provider Name (Legal Business Name): WENDY BEALS IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2013
Last Update Date: 11/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 GORHAM HEIGHTS RD
GORHAM NH
03581-4842
US

IV. Provider business mailing address

11 GORHAM HEIGHTS RD
GORHAM NH
03581-4842
US

V. Phone/Fax

Practice location:
  • Phone: 603-313-6276
  • Fax:
Mailing address:
  • Phone: 603-313-6276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-46917
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: