Provider Demographics
NPI:1164081816
Name:WENTZEL, LLC
Entity Type:Organization
Organization Name:WENTZEL, LLC
Other - Org Name:NOURISH INTEGRATIVE LACTATION & WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MEREDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:WENTZEL
Authorized Official - Suffix:
Authorized Official - Credentials:IBCLC
Authorized Official - Phone:864-757-4951
Mailing Address - Street 1:105 MEADOW BLOSSOM WAY
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-6588
Mailing Address - Country:US
Mailing Address - Phone:864-497-2655
Mailing Address - Fax:
Practice Address - Street 1:319 GARLINGTON RD STE D9
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-4610
Practice Address - Country:US
Practice Address - Phone:864-757-4951
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-06
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1255733432Medicaid