Provider Demographics
NPI:1336892009
Name:NIMITZ, MEREDITH CONRAD (RN, CPN, IBCLC)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:CONRAD
Last Name:NIMITZ
Suffix:
Gender:F
Credentials:RN, CPN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10000 COOMBS FARM RD STE 106
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-1157
Mailing Address - Country:US
Mailing Address - Phone:814-244-3836
Mailing Address - Fax:
Practice Address - Street 1:10000 COOMBS FARM RD STE 106
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508-1157
Practice Address - Country:US
Practice Address - Phone:814-244-3836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-01
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN630974163WL0100X
WV112231163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant