Healthcare Provider Details

I. General information

NPI: 1891183745
Provider Name (Legal Business Name): MS. CARRIE-MEGHAN QUICK-BLANCO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2014
Last Update Date: 12/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

923 8TH ST
HUNTINGTON WV
25701-2705
US

IV. Provider business mailing address

923 8TH ST
HUNTINGTON WV
25701-2705
US

V. Phone/Fax

Practice location:
  • Phone: 304-482-0544
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberALPP-200823
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: