Provider Demographics
NPI:1093334625
Name:VENABLE, TRACY (RN,IBCLC,RLC)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:VENABLE
Suffix:
Gender:F
Credentials:RN,IBCLC,RLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1684 HIGHWAY 752
Mailing Address - Street 2:
Mailing Address - City:CHURCH POINT
Mailing Address - State:LA
Mailing Address - Zip Code:70525-6704
Mailing Address - Country:US
Mailing Address - Phone:337-277-8685
Mailing Address - Fax:
Practice Address - Street 1:1684 HIGHWAY 752
Practice Address - Street 2:
Practice Address - City:CHURCH POINT
Practice Address - State:LA
Practice Address - Zip Code:70525-6704
Practice Address - Country:US
Practice Address - Phone:337-277-8685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-14
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN097093163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant