Provider Demographics
NPI:1720755101
Name:BOVENZI, RENEE ANNETTE (IBCLC)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:ANNETTE
Last Name:BOVENZI
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 1:1077 LORIMER ST # 3
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11222-2611
Mailing Address - Country:US
Mailing Address - Phone:917-658-4029
Mailing Address - Fax:
Practice Address - Street 1:1077 LORIMER ST # 3
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11222-2611
Practice Address - Country:US
Practice Address - Phone:917-658-4029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
303991174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN