Provider Demographics
NPI:1164800967
Name:PEDICINO, AGNES LYNN (RN,IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:AGNES
Middle Name:LYNN
Last Name:PEDICINO
Suffix:
Gender:F
Credentials:RN,IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 N HENRY ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11222-3607
Mailing Address - Country:US
Mailing Address - Phone:347-244-9491
Mailing Address - Fax:
Practice Address - Street 1:211 N HENRY ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11222-3607
Practice Address - Country:US
Practice Address - Phone:347-244-9491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-12
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY317619163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant