Provider Demographics
NPI:1003189218
Name:UTILLA, PAULA HARRISON (IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:HARRISON
Last Name:UTILLA
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:MRS
Other - First Name:PAULA
Other - Middle Name:FELICE
Other - Last Name:UTILLA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:IBCLC
Mailing Address - Street 1:2225 E 74TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-6603
Mailing Address - Country:US
Mailing Address - Phone:718-241-1818
Mailing Address - Fax:
Practice Address - Street 1:2225 E 74TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-6603
Practice Address - Country:US
Practice Address - Phone:718-241-1818
Practice Address - Fax:718-629-1359
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-17
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY11025248174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN