Provider Demographics
NPI:1164924304
Name:WOODEN, BIANCA TODD (IBCLC)
Entity Type:Individual
Prefix:
First Name:BIANCA
Middle Name:TODD
Last Name:WOODEN
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 1:136 SIOWAN AVE
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-5321
Mailing Address - Country:US
Mailing Address - Phone:228-233-0686
Mailing Address - Fax:
Practice Address - Street 1:136 SIOWAN AVE
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-5321
Practice Address - Country:US
Practice Address - Phone:228-233-0686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-04
Last Update Date:2018-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSL-110692174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN