Provider Demographics
NPI:1548864325
Name:KIRKPATRICK, TANA MARIE (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:TANA
Middle Name:MARIE
Last Name:KIRKPATRICK
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 1:268 BALLYMORE RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:19064-2302
Mailing Address - Country:US
Mailing Address - Phone:610-639-3648
Mailing Address - Fax:
Practice Address - Street 1:268 BALLYMORE RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:PA
Practice Address - Zip Code:19064-2302
Practice Address - Country:US
Practice Address - Phone:610-639-3648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN526826L163WL0100X
PAL-156372163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Multi-Specialty