Provider Demographics
NPI:1477212561
Name:SOUSA, ASHLEY (RN IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:
Last Name:SOUSA
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 1:11 JUNIPER TRL
Mailing Address - Street 2:
Mailing Address - City:NARRAGANSETT
Mailing Address - State:RI
Mailing Address - Zip Code:02882-2502
Mailing Address - Country:US
Mailing Address - Phone:401-487-8619
Mailing Address - Fax:
Practice Address - Street 1:11 JUNIPER TRL
Practice Address - Street 2:
Practice Address - City:NARRAGANSETT
Practice Address - State:RI
Practice Address - Zip Code:02882-2502
Practice Address - Country:US
Practice Address - Phone:401-487-8619
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-15
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILLC00077163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant