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General NPI Number Information
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NPI Number | 1245440189
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Entity Type | Individual
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Provider Name | CAROLE KIVETT BLANE BA, IBCLC
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Gender | Female
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 04/28/2010
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Provider Practice Location Address
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Address Line | 54 RIVERSIDE DR GRA
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City | NEW YORK
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State | NY
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Zip | 10024-6509
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Country | US
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Telephone | 917-407-1166
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Fax |
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Provider Business Mailing Address
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Address Line | 135 OWATONNA ST
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City | HAWORTH
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State | NJ
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Zip | 07641-1812
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Country | US
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Telephone | 917-407-1166
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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