Provider Demographics
NPI:1710768502
Name:CONNOLLY, NOREEN (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:NOREEN
Middle Name:
Last Name:CONNOLLY
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 1:247 BEACH 122ND ST
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11694-1824
Mailing Address - Country:US
Mailing Address - Phone:917-589-9231
Mailing Address - Fax:
Practice Address - Street 1:247 BEACH 122ND ST
Practice Address - Street 2:
Practice Address - City:ROCKAWAY PARK
Practice Address - State:NY
Practice Address - Zip Code:11694-1824
Practice Address - Country:US
Practice Address - Phone:917-589-9231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY633026163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant