Provider Demographics
NPI:1497468912
Name:KONDRAT, MELANIE (IBCLC)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:KONDRAT
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 1:7019 SAGE LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37931-4142
Mailing Address - Country:US
Mailing Address - Phone:586-770-9754
Mailing Address - Fax:
Practice Address - Street 1:7019 SAGE LN
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37931-4142
Practice Address - Country:US
Practice Address - Phone:586-770-9754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-29
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
309975174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Single Specialty