Provider Demographics
NPI:1437569001
Name:WALCOTT, LILLIAN NANETTE (MSN, RNC, IBCLC)
Entity Type:Individual
Prefix:
First Name:LILLIAN
Middle Name:NANETTE
Last Name:WALCOTT
Suffix:
Gender:F
Credentials:MSN, RNC, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 AVENUE PARSONS BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-2199
Mailing Address - Country:US
Mailing Address - Phone:718-670-3017
Mailing Address - Fax:718-670-3066
Practice Address - Street 1:45 AVENUE PARSONS BOULEVARD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-2199
Practice Address - Country:US
Practice Address - Phone:718-670-3017
Practice Address - Fax:718-670-3066
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-05
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY288643163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant