Individual
JACQUELINE TYSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN, IBCLC
Contact information
Practice address
613 NEMESIA DR, WENDELL, NC 27591-3229
(919) 280-0451
Mailing address
613 NEMESIA DR, WENDELL, NC 27591-3229
Taxonomy
Speciality
Code
Description
License number
State
163WL0100X
Lactation Consultant (Registered Nurse)
Primary
L-317528
NC
Other
Enumeration date
12/12/2025
Last updated
12/12/2025
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