Provider Demographics
NPI:1467345017
Name:PEDERSEN, KRISTINA (IBCLC)
Entity type:Individual
Prefix:MS
First Name:KRISTINA
Middle Name:
Last Name:PEDERSEN
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 1:46 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:EAST ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11518-2012
Mailing Address - Country:US
Mailing Address - Phone:516-916-8281
Mailing Address - Fax:
Practice Address - Street 1:46 4TH AVE
Practice Address - Street 2:
Practice Address - City:EAST ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11518-2012
Practice Address - Country:US
Practice Address - Phone:516-916-8281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-02
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
L-57964174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Single Specialty