Provider Demographics
NPI:1225594666
Name:HUDDLESTON, SARA DANIELLE (IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:DANIELLE
Last Name:HUDDLESTON
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 JONES ST
Mailing Address - Street 2:
Mailing Address - City:OLD HICKORY
Mailing Address - State:TN
Mailing Address - Zip Code:37138-2935
Mailing Address - Country:US
Mailing Address - Phone:615-403-9018
Mailing Address - Fax:
Practice Address - Street 1:1200 JONES ST
Practice Address - Street 2:
Practice Address - City:OLD HICKORY
Practice Address - State:TN
Practice Address - Zip Code:37138-2935
Practice Address - Country:US
Practice Address - Phone:615-403-9018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-11
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
L-152482174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN