Provider Demographics
NPI:1508580044
Name:TRUESDALE, ELIZABETH (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:TRUESDALE
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 1:34 ORCHARD HILL RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37334-6363
Mailing Address - Country:US
Mailing Address - Phone:931-675-0726
Mailing Address - Fax:
Practice Address - Street 1:34 ORCHARD HILL RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37334-6363
Practice Address - Country:US
Practice Address - Phone:931-675-0726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-28
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN208770163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant