Provider Demographics
NPI:1740640606
Name:KNIGHT, WENDY C (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:C
Last Name:KNIGHT
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 1:7902 SLEEPY LAGOON WAY
Mailing Address - Street 2:
Mailing Address - City:FLOWERY BRANCH
Mailing Address - State:GA
Mailing Address - Zip Code:30542-7556
Mailing Address - Country:US
Mailing Address - Phone:678-231-0343
Mailing Address - Fax:
Practice Address - Street 1:7902 SLEEPY LAGOON WAY
Practice Address - Street 2:
Practice Address - City:FLOWERY BRANCH
Practice Address - State:GA
Practice Address - Zip Code:30542-7556
Practice Address - Country:US
Practice Address - Phone:678-231-0343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-03
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN160467163W00000X
GAL-28068163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163W00000XNursing Service ProvidersRegistered Nurse