Healthcare Provider Details

I. General information

NPI: 1295563492
Provider Name (Legal Business Name): GRACE LYMAN CAUDILL IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2024
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 BURCHWOOD AVE
NASHVILLE TN
37216-3605
US

IV. Provider business mailing address

909 BURCHWOOD AVE
NASHVILLE TN
37216-3605
US

V. Phone/Fax

Practice location:
  • Phone: 504-952-3821
  • Fax:
Mailing address:
  • Phone: 504-952-3821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-315062
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: