Provider Demographics
NPI:1376130799
Name:WENGER, AMY LYNN (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LYNN
Last Name:WENGER
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 1:6167 PLOTT RD
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05492-9743
Mailing Address - Country:US
Mailing Address - Phone:802-922-0405
Mailing Address - Fax:
Practice Address - Street 1:6167 PLOTT RD
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:VT
Practice Address - Zip Code:05492-9743
Practice Address - Country:US
Practice Address - Phone:802-922-0405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-31
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT026.0103875163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant