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General NPI Number Information
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NPI Number | 1497961361
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Entity Type | Individual
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Provider Name | MELISSA LORI KOTLEN RN, IBCLC
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Gender | Female
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 02/09/2024
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Provider Practice Location Address
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Address Line | 175 E 96TH ST APT 18O
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City | NEW YORK
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State | NY
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Zip | 10128-6209
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Country | US
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Telephone | 914-374-1632
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Fax |
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Provider Business Mailing Address
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Address Line | 175 E 96TH ST APT 18O
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City | NEW YORK
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State | NY
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Zip | 10128-6209
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Country | US
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Telephone | 914-374-1632
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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 | 163WL0100X
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Taxonomy Name | Lactation Consultant (Registered Nurse)
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License Number | 785274-01
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License Number State | NY
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Taxonomy #2
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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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