Provider Demographics
NPI:1184095085
Name:BURTON-EASTERBROOK, AUDRA (RAN, IBCLC)
Entity type:Individual
Prefix:
First Name:AUDRA
Middle Name:
Last Name:BURTON-EASTERBROOK
Suffix:
Gender:F
Credentials:RAN, 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 ALGONQUIN WAY
Mailing Address - Street 2:
Mailing Address - City:WEST MILFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07480-4102
Mailing Address - Country:US
Mailing Address - Phone:973-650-9828
Mailing Address - Fax:
Practice Address - Street 1:34 ALGONQUIN WAY
Practice Address - Street 2:
Practice Address - City:WEST MILFORD
Practice Address - State:NJ
Practice Address - Zip Code:07480-4102
Practice Address - Country:US
Practice Address - Phone:973-650-9828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-18
Last Update Date:2015-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO12394800163WL0100X
NJL-13659163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant