Provider Demographics
NPI:1952660946
Name:PELUSO, NICOLE (IBCLC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:PELUSO
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 HILL RD
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-4043
Mailing Address - Country:US
Mailing Address - Phone:323-595-4006
Mailing Address - Fax:310-872-1533
Practice Address - Street 1:34 HILL RD
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-4043
Practice Address - Country:US
Practice Address - Phone:323-595-4006
Practice Address - Fax:310-872-1533
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTL-24523174N00000X
CA11174390174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN