Provider Demographics
NPI:1184403743
Name:RODRIGUEZ-NINMAN, STEPHANIE (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:RODRIGUEZ-NINMAN
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 1:170 TILLARY ST APT 506
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-2060
Mailing Address - Country:US
Mailing Address - Phone:612-310-0368
Mailing Address - Fax:
Practice Address - Street 1:170 TILLARY ST APT 506
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-2060
Practice Address - Country:US
Practice Address - Phone:612-310-0368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY659955163WX0003X, 163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163WX0003XNursing Service ProvidersRegistered NurseObstetric, Inpatient