Provider Demographics
NPI:1134420540
Name:PHILLIPS, TANYA MARIE (IBCLC, CD)
Entity type:Individual
Prefix:MS
First Name:TANYA
Middle Name:MARIE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:IBCLC, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9874 WIER LOOP CIR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78736-7847
Mailing Address - Country:US
Mailing Address - Phone:512-560-3732
Mailing Address - Fax:206-666-5186
Practice Address - Street 1:9874 WIER LOOP CIR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78736-7847
Practice Address - Country:US
Practice Address - Phone:512-560-3732
Practice Address - Fax:206-666-5186
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-16
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19915901174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN