Provider Demographics
NPI:1447659867
Name:WYDNER, SARAH ELIZABETH (RN, IBCLC)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:ELIZABETH
Last Name:WYDNER
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 1:1709 MILL LANDING RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23457-1442
Mailing Address - Country:US
Mailing Address - Phone:757-297-2843
Mailing Address - Fax:
Practice Address - Street 1:2621 HARTLEY ST
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-6549
Practice Address - Country:US
Practice Address - Phone:757-297-2843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-21
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDL-50268174N00000X
VAL50268163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty
No174N00000XOther Service ProvidersLactation Consultant, Non-RN
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1447659867OtherIN PROCESS