Provider Demographics
NPI:1386108058
Name:NATERO, ANGIE LYNN (RN IBCLC)
Entity type:Individual
Prefix:MRS
First Name:ANGIE
Middle Name:LYNN
Last Name:NATERO
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 1:2144 LEATHERWOOD RD
Mailing Address - Street 2:
Mailing Address - City:STEWART
Mailing Address - State:TN
Mailing Address - Zip Code:37175-4084
Mailing Address - Country:US
Mailing Address - Phone:931-627-2457
Mailing Address - Fax:
Practice Address - Street 1:301 TYSON AVE
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TN
Practice Address - Zip Code:38242-4544
Practice Address - Country:US
Practice Address - Phone:731-644-8510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-28
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN150840163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant