Healthcare Provider Details

I. General information

NPI: 1871882761
Provider Name (Legal Business Name): SUSAN LEA BREMMER IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2011
Last Update Date: 11/08/2024
Certification Date: 11/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4678 N SWEET BAY LN
LAKE HAVASU CITY AZ
86404-5401
US

IV. Provider business mailing address

4678 N SWEET BAY LN
LAKE HAVASU CITY AZ
86404-5401
US

V. Phone/Fax

Practice location:
  • Phone: 303-810-2669
  • Fax:
Mailing address:
  • Phone: 303-810-2669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number10218781
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-33965
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: