Healthcare Provider Details

I. General information

NPI: 1811527062
Provider Name (Legal Business Name): KATHLEEN MURPHY POWERS RN IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2020
Last Update Date: 01/16/2020
Certification Date: 01/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 2ND ST E STE 3F
BRADENTON FL
34208-1027
US

IV. Provider business mailing address

108 25TH ST W
BRADENTON FL
34205-4323
US

V. Phone/Fax

Practice location:
  • Phone: 941-745-6925
  • Fax: 941-745-6926
Mailing address:
  • Phone: 941-773-4518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number622232
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: