Provider Demographics
NPI:1003390725
Name:WILSON, BETH (BS, IBCLC, RLC)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:BS, IBCLC, RLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2958 HANOVER DR
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805-2926
Mailing Address - Country:US
Mailing Address - Phone:419-234-3929
Mailing Address - Fax:
Practice Address - Street 1:2958 HANOVER DR
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805-2926
Practice Address - Country:US
Practice Address - Phone:419-234-3929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-18
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN