Provider Demographics
NPI:1134874738
Name:MCILHENNY, NINA (RN, BSN, IBCLC)
Entity type:Individual
Prefix:MRS
First Name:NINA
Middle Name:
Last Name:MCILHENNY
Suffix:
Gender:F
Credentials:RN, BSN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12520 RICHTON RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19154-1916
Mailing Address - Country:US
Mailing Address - Phone:215-350-1115
Mailing Address - Fax:
Practice Address - Street 1:12520 RICHTON RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19154-1916
Practice Address - Country:US
Practice Address - Phone:215-350-1115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-14
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAL-303761163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant