Healthcare Provider Details

I. General information

NPI: 1952660946
Provider Name (Legal Business Name): NICOLE PELUSO IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2012
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 HILL RD
GREENWICH CT
06830-4043
US

IV. Provider business mailing address

34 HILL RD
GREENWICH CT
06830-4043
US

V. Phone/Fax

Practice location:
  • Phone: 323-595-4006
  • Fax: 310-872-1533
Mailing address:
  • Phone: 323-595-4006
  • Fax: 310-872-1533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-24523
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number11174390
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: