Healthcare Provider Details

I. General information

NPI: 1154894392
Provider Name (Legal Business Name): FELICIA MICHELE AHLBORN RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2019
Last Update Date: 01/11/2025
Certification Date: 01/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

745 PELTON AVE
STATEN ISLAND NY
10310-3141
US

IV. Provider business mailing address

745 PELTON AVE
STATEN ISLAND NY
10310-3141
US

V. Phone/Fax

Practice location:
  • Phone: 347-613-2101
  • Fax:
Mailing address:
  • Phone: 347-613-2101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number551374
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WX0002X
TaxonomyHigh-Risk Obstetric Registered Nurse
License Number551374
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number551374
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License Number551374
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number551374
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number551374
License Number StateNY
# 7
Primary TaxonomyN
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number551374
License Number StateNY
# 8
Primary TaxonomyN
Taxonomy Code163WN0003X
TaxonomyLow-Risk Neonatal Registered Nurse
License Number551374
License Number StateNY
# 9
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number551374
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: