Provider Demographics
NPI:1770275497
Name:EAST TENNESSEE LACTATION LLC
Entity type:Organization
Organization Name:EAST TENNESSEE LACTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:IBCLC
Authorized Official - Phone:423-435-3184
Mailing Address - Street 1:113 COUNTY ROAD 584
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37329-5101
Mailing Address - Country:US
Mailing Address - Phone:423-435-3184
Mailing Address - Fax:
Practice Address - Street 1:113 COUNTY ROAD 584
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:TN
Practice Address - Zip Code:37329-5101
Practice Address - Country:US
Practice Address - Phone:423-435-3184
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Single Specialty