MEDICARE: KAREN B CLAIRDAY RN, IBCLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WL0100X	Lactation Consultant (Registered Nurse)	RN0000077440	TN

General Provider Information

NPI Number	:	1558144485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN B CLAIRDAY RN, IBCLC

Provider Business Mailing Address
First Line	:	1041 COOKS RD
Second Line	:
City	:	MOUNT JULIET
State	:	TN
Zip	:	37122-5721
Country	:	US
Telephone Number	:	615-948-1736
Fax Number	:

Provider Business Practice Location Address
First Line	:	1041 COOKS RD
Second Line	:
City	:	MOUNT JULIET
State	:	TN
Zip	:	37122-5721
Country	:	US
Telephone Number	:	615-948-1736
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2023
Last Update Date	:	08/17/2023

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