Individual
AUDRA WELLINGTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LVN, BSC, CLC
Contact information
Practice address
1201 S MAIN ST, FORT WORTH, TX 76104-4804
(817) 702-6524
(817) 702-6593
Mailing address
1201 S MAIN ST, FORT WORTH, TX 76104-4804
(817) 702-6524
(817) 702-6593
Taxonomy
Speciality
Code
Description
License number
State
174N00000X
Lactation Consultant (Non-RN)
Primary
201275
TX
Other
Enumeration date
05/27/2014
Last updated
05/27/2014
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