Provider Demographics
NPI:1548686090
Name:TENNERIELLO, CAROL (RN, IBCLC)
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:
Last Name:TENNERIELLO
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:SUE
Other - Last Name:TENNE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7433 SPRAGUE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19119-1037
Mailing Address - Country:US
Mailing Address - Phone:215-248-0197
Mailing Address - Fax:
Practice Address - Street 1:7433 SPRAGUE ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19119-1037
Practice Address - Country:US
Practice Address - Phone:215-248-0197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-07
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN269165L163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant