Provider Demographics
NPI:1063751576
Name:BLYTHE, GRETTA HALL (RN, IBCLC)
Entity type:Individual
Prefix:MS
First Name:GRETTA
Middle Name:HALL
Last Name:BLYTHE
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:MISS
Other - First Name:GRETTA
Other - Middle Name:JANE
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:5127 BOULWARE CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-9643
Mailing Address - Country:US
Mailing Address - Phone:704-578-6323
Mailing Address - Fax:704-846-3421
Practice Address - Street 1:5127 BOULWARE CT
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-9643
Practice Address - Country:US
Practice Address - Phone:704-578-6323
Practice Address - Fax:704-846-3421
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-04
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC70351163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant