Provider Demographics
NPI:1821204520
Name:WOELFEL, MARY LARKINS (IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:LARKINS
Last Name:WOELFEL
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 1:700 S ROSE ST
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95240-3920
Mailing Address - Country:US
Mailing Address - Phone:209-334-6360
Mailing Address - Fax:
Practice Address - Street 1:700 S ROSE ST
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-3920
Practice Address - Country:US
Practice Address - Phone:209-334-6360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist