Healthcare Provider Details

I. General information

NPI: 1598213639
Provider Name (Legal Business Name): MARGUERITE WACHUNAS RN, IBCLC, BA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2016
Last Update Date: 09/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 OLENTANGY RIVER RD WOMENS CENTER
COLUMBUS OH
43214-3908
US

IV. Provider business mailing address

2405 EDGEVALE RD
COLUMBUS OH
43221-1217
US

V. Phone/Fax

Practice location:
  • Phone: 614-566-3434
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberRN096292
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: