Healthcare Provider Details

I. General information

NPI: 1427963008
Provider Name (Legal Business Name): WENDY L VAZQUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69 MONROE ST STE B
LODI NJ
07644-3042
US

IV. Provider business mailing address

69 MONROE ST STE B
LODI NJ
07644-3042
US

V. Phone/Fax

Practice location:
  • Phone: 862-406-8130
  • Fax:
Mailing address:
  • Phone: 201-580-5195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-322763
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: