MEDICARE: MS. GLADYS MARIA VALLESPIR ELLETT RN, IBCLC, LCCE

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	163WL0100X	Lactation Consultant (Registered Nurse)	514546	NY

General Provider Information

NPI Number	:	1710555172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. GLADYS MARIA VALLESPIR ELLETT RN, IBCLC, LCCE

Provider Business Mailing Address
First Line	:	6804 NARROWS AVE APT 1
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-5013
Country	:	US
Telephone Number	:	201-573-0584
Fax Number	:

Provider Business Practice Location Address
First Line	:	6804 NARROWS AVE APT 1
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-5013
Country	:	US
Telephone Number	:	201-573-0584
Fax Number	:

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

Provider Enumeration Date	:	06/14/2021
Last Update Date	:	06/14/2021

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