Provider Demographics
NPI:1528820651
Name:WHITFORD, WENDY (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:WHITFORD
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12633 LILLYBROOK LN
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-5747
Mailing Address - Country:US
Mailing Address - Phone:817-995-0287
Mailing Address - Fax:
Practice Address - Street 1:12633 LILLYBROOK LN
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-5747
Practice Address - Country:US
Practice Address - Phone:817-995-0287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-24
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX821549163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant