Provider Demographics
NPI:1710664651
Name:TENNESSEE LACTATION CARE LLC
Entity Type:Organization
Organization Name:TENNESSEE LACTATION CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, LACTATION CONSULTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:PLUNKETT
Authorized Official - Suffix:
Authorized Official - Credentials:RN, IBCLC
Authorized Official - Phone:615-656-0839
Mailing Address - Street 1:1488 JOHN WINDROW RD
Mailing Address - Street 2:
Mailing Address - City:EAGLEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37060-4021
Mailing Address - Country:US
Mailing Address - Phone:615-656-0839
Mailing Address - Fax:901-466-6994
Practice Address - Street 1:1488 JOHN WINDROW RD
Practice Address - Street 2:
Practice Address - City:EAGLEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37060-4021
Practice Address - Country:US
Practice Address - Phone:615-656-0839
Practice Address - Fax:901-466-6994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Multi-Specialty
No174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ082537Medicaid
TN31455031OtherAETNA