Provider Demographics
NPI:1548084809
Name:LOUISAIRE, FENDA L (MPH RN, IBCLC)
Entity type:Individual
Prefix:MRS
First Name:FENDA
Middle Name:L
Last Name:LOUISAIRE
Suffix:
Gender:F
Credentials:MPH RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:447 BROADWAY
Mailing Address - Street 2:2ND FLOOR #1060
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013
Mailing Address - Country:US
Mailing Address - Phone:917-478-9838
Mailing Address - Fax:
Practice Address - Street 1:447 BROADWAY
Practice Address - Street 2:2ND FLOOR #1060
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013
Practice Address - Country:US
Practice Address - Phone:917-478-9838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-13
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYL-87236163WL0100X
NY582982-1163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant