Provider Demographics
NPI:1255610374
Name:PRYBYLSKI, KATHLEEN (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:PRYBYLSKI
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 1:2 WREN WAY
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07731-2047
Mailing Address - Country:US
Mailing Address - Phone:732-367-0721
Mailing Address - Fax:
Practice Address - Street 1:2 WREN WAY
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:NJ
Practice Address - Zip Code:07731-2047
Practice Address - Country:US
Practice Address - Phone:732-367-0721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-07
Last Update Date:2011-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ19512825163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant