Healthcare Provider Details

I. General information

NPI: 1508201344
Provider Name (Legal Business Name): NATASHA ROSE BROCKHAUS B.S., IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2013
Last Update Date: 05/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2780 W CARR HILL RD
COLUMBUS IN
47201-4984
US

IV. Provider business mailing address

2780 W CARR HILL RD
COLUMBUS IN
47201-4984
US

V. Phone/Fax

Practice location:
  • Phone: 812-374-2746
  • Fax: 812-375-0949
Mailing address:
  • Phone: 812-374-2746
  • Fax: 812-375-0949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number11184180
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: