Provider Demographics
NPI:1902235252
Name:BEALS, WENDY (IBCLC)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:BEALS
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 GORHAM HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:GORHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03581-4842
Mailing Address - Country:US
Mailing Address - Phone:603-313-6276
Mailing Address - Fax:
Practice Address - Street 1:11 GORHAM HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:GORHAM
Practice Address - State:NH
Practice Address - Zip Code:03581-4842
Practice Address - Country:US
Practice Address - Phone:603-313-6276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHL-46917163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant