Provider Demographics
NPI:1013500925
Name:OUTRAM, DENEIGE (RN, IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:DENEIGE
Middle Name:
Last Name:OUTRAM
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 1:1277 E 87TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-4901
Mailing Address - Country:US
Mailing Address - Phone:646-206-0118
Mailing Address - Fax:
Practice Address - Street 1:1277 E 87TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-4901
Practice Address - Country:US
Practice Address - Phone:646-206-0118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-11
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY674484163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse