Provider Demographics
NPI:1730438839
Name:MYATT, TAMMY WELCH (IBCLC, RLC)
Entity type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:WELCH
Last Name:MYATT
Suffix:
Gender:F
Credentials:IBCLC, RLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 LAUCHWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:LAURINBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28352-5501
Mailing Address - Country:US
Mailing Address - Phone:910-291-6806
Mailing Address - Fax:910-291-7818
Practice Address - Street 1:500 LAUCHWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:LAURINBURG
Practice Address - State:NC
Practice Address - Zip Code:28352-5501
Practice Address - Country:US
Practice Address - Phone:910-291-6806
Practice Address - Fax:910-291-7818
Is Sole Proprietor?:No
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC10016720OtherINTERNATIONAL BOARD CERTIFIED LACTATION CONSULTANT