Provider Demographics
NPI:1467091108
Name:DAILEY, LYDIA (IBCLC)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:
Last Name:DAILEY
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:LYDIA
Other - Middle Name:
Other - Last Name:MCGREW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:IBCLC
Mailing Address - Street 1:1328 BURCHETT DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37042-6767
Mailing Address - Country:US
Mailing Address - Phone:615-972-5395
Mailing Address - Fax:
Practice Address - Street 1:1328 BURCHETT DR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37042-6767
Practice Address - Country:US
Practice Address - Phone:615-972-5395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-28
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNL-49712163WL0100X
L-49712174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN250921OtherTN BOARD OF NURSING
L-49712OtherIBLCE