Provider Demographics
NPI:1497370654
Name:RENNAKER, TAMERA (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:TAMERA
Middle Name:
Last Name:RENNAKER
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4351 FAIRWOOD CT
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94521-1346
Mailing Address - Country:US
Mailing Address - Phone:925-381-3638
Mailing Address - Fax:
Practice Address - Street 1:4351 FAIRWOOD CT
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94521-1346
Practice Address - Country:US
Practice Address - Phone:925-381-3638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-13
Last Update Date:2020-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA527653163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant