Provider Demographics
NPI:1558869248
Name:FAYRE, JUDITH WREN (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:WREN
Last Name:FAYRE
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 1:7 S POND ST
Mailing Address - Street 2:
Mailing Address - City:NEWBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01951-1219
Mailing Address - Country:US
Mailing Address - Phone:603-568-8282
Mailing Address - Fax:978-358-7247
Practice Address - Street 1:7 S POND ST
Practice Address - Street 2:
Practice Address - City:NEWBURY
Practice Address - State:MA
Practice Address - Zip Code:01951-1219
Practice Address - Country:US
Practice Address - Phone:603-568-8282
Practice Address - Fax:978-358-7247
Is Sole Proprietor?:No
Enumeration Date:2018-01-27
Last Update Date:2018-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11139330163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant