Provider Demographics
NPI:1922783984
Name:CONNOR, PAULA RENEE (IBCLC)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:RENEE
Last Name:CONNOR
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 1:8310 FRONT GATE CIR
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-9506
Mailing Address - Country:US
Mailing Address - Phone:334-303-0766
Mailing Address - Fax:
Practice Address - Street 1:8310 FRONT GATE CIR
Practice Address - Street 2:
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-9506
Practice Address - Country:US
Practice Address - Phone:334-303-0766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-19
Last Update Date:2023-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNL-126567163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant