Individual
MISS MARY THERESE SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BSN, RNC-NIC, IBCLC
Contact information
Practice address
205 S ORANGE ST, APT B, MEDIA, PA 19063-3110
(610) 368-7258
Mailing address
205 S ORANGE ST, APT B, MEDIA, PA 19063-3110
(610) 368-7258
Taxonomy
Speciality
Code
Description
License number
State
163WL0100X
Lactation Consultant (Registered Nurse)
Primary
L-77562
PA
Other
Enumeration date
05/19/2016
Last updated
05/19/2016
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