Provider Demographics
NPI:1518261916
Name:FONTINELL, FLANNERY GREGG (RN, IBCLC, LCCE)
Entity Type:Individual
Prefix:MS
First Name:FLANNERY
Middle Name:GREGG
Last Name:FONTINELL
Suffix:
Gender:F
Credentials:RN, IBCLC, LCCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 COLUMBUS AVE
Mailing Address - Street 2:APT 20-D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-6662
Mailing Address - Country:US
Mailing Address - Phone:212-749-3490
Mailing Address - Fax:
Practice Address - Street 1:700 COLUMBUS AVE
Practice Address - Street 2:APT 20-D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-6662
Practice Address - Country:US
Practice Address - Phone:212-749-3490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-29
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY11097653163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant