Provider Demographics
NPI:1083161772
Name:CARBONE-PELLERIN, NINA (IBCLC)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:
Last Name:CARBONE-PELLERIN
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:NINA
Other - Middle Name:
Other - Last Name:CARBONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:IBCLC
Mailing Address - Street 1:2634 MLK JR WAY
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-3238
Mailing Address - Country:US
Mailing Address - Phone:510-331-6462
Mailing Address - Fax:
Practice Address - Street 1:2634 MLK JR WAY
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-3238
Practice Address - Country:US
Practice Address - Phone:510-331-6462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-09
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN