Healthcare Provider Details

I. General information

NPI: 1497096952
Provider Name (Legal Business Name): JULIE RENE CARTLEDGE RN, IBCLC, CLC, CLS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2013
Last Update Date: 06/03/2020
Certification Date: 06/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7902 S 71ST EAST AVE
TULSA OK
74133-7819
US

IV. Provider business mailing address

7902 S 71ST EAST AVE
TULSA OK
74133-7819
US

V. Phone/Fax

Practice location:
  • Phone: 918-999-6010
  • Fax:
Mailing address:
  • Phone: 918-999-6010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberR0074902
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: