Provider Demographics
NPI:1730597949
Name:KRAMER, ROSE (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:
Last Name:KRAMER
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:SHOSHANA ROSE
Other - Middle Name:
Other - Last Name:GOLDMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN, IBCLC
Mailing Address - Street 1:14735 77TH AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-3123
Mailing Address - Country:US
Mailing Address - Phone:914-450-1769
Mailing Address - Fax:
Practice Address - Street 1:14735 77TH AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-3123
Practice Address - Country:US
Practice Address - Phone:914-450-1769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-31
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22 609627163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant