Provider Demographics
NPI:1285051979
Name:RICHARDSON, AUBREY (RN, BSN, BA, IBCLC)
Entity type:Individual
Prefix:
First Name:AUBREY
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:RN, BSN, BA, 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 MAPLE ST APT D1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-5033
Mailing Address - Country:US
Mailing Address - Phone:847-682-2511
Mailing Address - Fax:
Practice Address - Street 1:11 MAPLE ST APT D1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-5033
Practice Address - Country:US
Practice Address - Phone:847-682-2511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-20
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY682251163W00000X
NYL-99185163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant