Provider Demographics
NPI:1710555172
Name:VALLESPIR ELLETT, GLADYS MARIA (RN, IBCLC, LCCE)
Entity Type:Individual
Prefix:MS
First Name:GLADYS
Middle Name:MARIA
Last Name:VALLESPIR ELLETT
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 1:6804 NARROWS AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-5013
Mailing Address - Country:US
Mailing Address - Phone:201-573-0584
Mailing Address - Fax:
Practice Address - Street 1:6804 NARROWS AVE APT 1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-5013
Practice Address - Country:US
Practice Address - Phone:201-573-0584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-14
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY514546163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant