Healthcare Provider Details

I. General information

NPI: 1811791254
Provider Name (Legal Business Name): BROOKE REED RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2025
Last Update Date: 04/03/2025
Certification Date: 04/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 ULUKAHIKI ST
KAILUA HI
96734-4454
US

IV. Provider business mailing address

172 W AVENIDA JUNIPERO
SAN CLEMENTE CA
92672-4338
US

V. Phone/Fax

Practice location:
  • Phone: 808-263-5500
  • Fax:
Mailing address:
  • Phone: 832-495-9085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-309658
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: