Healthcare Provider Details

I. General information

NPI: 1710664651
Provider Name (Legal Business Name): TENNESSEE LACTATION CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2023
Last Update Date: 07/03/2023
Certification Date: 07/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1488 JOHN WINDROW RD
EAGLEVILLE TN
37060-4021
US

IV. Provider business mailing address

1488 JOHN WINDROW RD
EAGLEVILLE TN
37060-4021
US

V. Phone/Fax

Practice location:
  • Phone: 615-656-0839
  • Fax: 901-466-6994
Mailing address:
  • Phone: 615-656-0839
  • Fax: 901-466-6994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANGELA PLUNKETT
Title or Position: OWNER, LACTATION CONSULTANT
Credential: RN, IBCLC
Phone: 615-656-0839