Provider Demographics
NPI:1457178402
Name:MUZTAFAGO, NANCY LILLIAN (RN,IBCLC)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:LILLIAN
Last Name:MUZTAFAGO
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 1:15 LONG AVE
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-5415
Mailing Address - Country:US
Mailing Address - Phone:518-421-8530
Mailing Address - Fax:
Practice Address - Street 1:15 LONG AVE
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-5415
Practice Address - Country:US
Practice Address - Phone:518-421-8530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY450853-01163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty