Provider Demographics
NPI:1053950568
Name:ITRI, ANGELINA (IBCLC)
Entity type:Individual
Prefix:MRS
First Name:ANGELINA
Middle Name:
Last Name:ITRI
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 1:1506 MAYS LANDING RD
Mailing Address - Street 2:
Mailing Address - City:HAMMONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08037-2857
Mailing Address - Country:US
Mailing Address - Phone:609-576-8841
Mailing Address - Fax:
Practice Address - Street 1:915 HADDON AVE
Practice Address - Street 2:
Practice Address - City:COLLINGSWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08108-1900
Practice Address - Country:US
Practice Address - Phone:609-576-8841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-31
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ165071174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN