Provider Demographics
NPI:1518431782
Name:KLEMME, KRISTEN (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:KLEMME
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 1:585 IRVING PL
Mailing Address - Street 2:
Mailing Address - City:NORTH BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-2236
Mailing Address - Country:US
Mailing Address - Phone:646-554-3035
Mailing Address - Fax:
Practice Address - Street 1:585 IRVING PL
Practice Address - Street 2:
Practice Address - City:NORTH BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-2236
Practice Address - Country:US
Practice Address - Phone:646-554-3035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-21
Last Update Date:2019-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY609879-1163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant