Provider Demographics
NPI:1992173728
Name:POKHAREL-WOOD, MIRIAM (IBCLC, MSW)
Entity type:Individual
Prefix:
First Name:MIRIAM
Middle Name:
Last Name:POKHAREL-WOOD
Suffix:
Gender:F
Credentials:IBCLC, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10400 SHAKER DR UNIT 295
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21150-7512
Mailing Address - Country:US
Mailing Address - Phone:215-206-2654
Mailing Address - Fax:
Practice Address - Street 1:10400 SHAKER DR UNIT 295
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:MD
Practice Address - Zip Code:21150-7512
Practice Address - Country:US
Practice Address - Phone:215-206-2654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-10
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
L-143172174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN