Provider Demographics
NPI:1689262594
Name:CREMEDY RAVENELL, LILLIAN (DOULA)
Entity Type:Individual
Prefix:
First Name:LILLIAN
Middle Name:
Last Name:CREMEDY RAVENELL
Suffix:
Gender:F
Credentials:DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:198 DRIFT AVE
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-3540
Mailing Address - Country:US
Mailing Address - Phone:718-419-9897
Mailing Address - Fax:
Practice Address - Street 1:198 DRIFT AVE
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08648-3540
Practice Address - Country:US
Practice Address - Phone:718-419-9897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-06
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula