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NPI Code Detail

MEDICARE: MRS. MARY MICHELLE MCPHERSON RN, IBCLC

MEDICARE: MRS. MARY MICHELLE MCPHERSON 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
1163WL0100XLactation Consultant (Registered Nurse)0000110525TN

General Provider Information

NPI Number : 1912781261
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MARY MICHELLE MCPHERSON RN, IBCLC
Provider Business Mailing Address
First Line : 2121 OLD BELFAST RD
Second Line :
City : LEWISBURG
State : TN
Zip : 37091-7138
Country : US
Telephone Number : 931-580-0879
Fax Number :
Provider Business Practice Location Address
First Line : 719 THOMPSON LN STE 27100
Second Line :
City : NASHVILLE
State : TN
Zip : 37204-4684
Country : US
Telephone Number : 615-343-5700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/18/2023
Last Update Date : 08/18/2023

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