Healthcare Provider Details

I. General information

NPI: 1437996535
Provider Name (Legal Business Name): SUMMER RANGE RN, CLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2024
Last Update Date: 07/15/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 MONKS WAY
FRANKLIN TN
37064-2907
US

IV. Provider business mailing address

207 MONKS WAY
FRANKLIN TN
37064-2907
US

V. Phone/Fax

Practice location:
  • Phone: 615-686-7884
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number259780
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: