Provider Demographics
NPI:1639806920
Name:WALL, TRICIA PAGE (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:TRICIA
Middle Name:PAGE
Last Name:WALL
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 1:100 COTTONWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37069-4164
Mailing Address - Country:US
Mailing Address - Phone:615-714-7065
Mailing Address - Fax:
Practice Address - Street 1:100 COTTONWOOD CIR
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37069-4164
Practice Address - Country:US
Practice Address - Phone:615-714-7065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-05
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000130720163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant