Individual
SAMANTHA A METKO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RDN, IBCLC
Contact information
Practice address
N3075 BEAN CITY RD, NEW LONDON, WI 54961-8912
(920) 540-0094
Mailing address
N3075 BEAN CITY RD, NEW LONDON, WI 54961-8912
(920) 540-0094
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
661-29
WI
174N00000X
Lactation Consultant (Non-RN)
L-22761
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
661-29
STATE OF WISCONSIN: DEPARTMENT OF SAFETY PROFESSIONAL SERVICES
WI
01
—
L-22761
IBCLC
—
Enumeration date
05/20/2019
Last updated
09/10/2019
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