MEDICARE: MRS. ASHLEY SOUSA RN IBCLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374J00000X	Doula	201987	RI
2	163WL0100X	Lactation Consultant (Registered Nurse)	LLC00077	RI

General Provider Information

NPI Number	:	1477212561
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ASHLEY SOUSA RN IBCLC

Provider Business Mailing Address
First Line	:	11 JUNIPER TRL
Second Line	:
City	:	NARRAGANSETT
State	:	RI
Zip	:	02882-2502
Country	:	US
Telephone Number	:	401-487-8619
Fax Number	:

Provider Business Practice Location Address
First Line	:	11 JUNIPER TRL
Second Line	:
City	:	NARRAGANSETT
State	:	RI
Zip	:	02882-2502
Country	:	US
Telephone Number	:	401-487-8619
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/15/2021
Last Update Date	:	01/23/2026

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