Provider Demographics
NPI:1740983980
Name:PEPE, GINA MARIE (IBCLC)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:MARIE
Last Name:PEPE
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 NASHUA RD
Mailing Address - Street 2:
Mailing Address - City:PUTNAM VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10579-1711
Mailing Address - Country:US
Mailing Address - Phone:347-413-3667
Mailing Address - Fax:
Practice Address - Street 1:11 NASHUA RD
Practice Address - Street 2:
Practice Address - City:PUTNAM VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10579-1711
Practice Address - Country:US
Practice Address - Phone:347-413-3667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYL-310452163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant