Provider Demographics
NPI:1679952766
Name:FUENTES, CARMEN (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:
Last Name:FUENTES
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 1:130 GLENBROOK PKWY
Mailing Address - Street 2:4F
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-2158
Mailing Address - Country:US
Mailing Address - Phone:914-629-8121
Mailing Address - Fax:
Practice Address - Street 1:130 GLENBROOK PKWY
Practice Address - Street 2:4F
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-2158
Practice Address - Country:US
Practice Address - Phone:914-629-8121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-22
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY400753-1163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant