Provider Demographics
NPI:1881419778
Name:MERRITT, TERESA (RN,IBCLC)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:MERRITT
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 1:1210 GADD RD
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-3917
Mailing Address - Country:US
Mailing Address - Phone:701-690-7243
Mailing Address - Fax:
Practice Address - Street 1:1210 GADD RD
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-3917
Practice Address - Country:US
Practice Address - Phone:701-690-7243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN213334163WR1000X, 163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163WR1000XNursing Service ProvidersRegistered NurseReproductive Endocrinology/Infertility