Healthcare Provider Details

I. General information

NPI: 1780950238
Provider Name (Legal Business Name): HEIDI T BEHRENDS RN BSN IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2012
Last Update Date: 03/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1245 CHARNELTON ST SUITE #7
EUGENE OR
97401-6214
US

IV. Provider business mailing address

1245 CHARNELTON ST SUITE #7
EUGENE OR
97401-6214
US

V. Phone/Fax

Practice location:
  • Phone: 541-556-4240
  • Fax:
Mailing address:
  • Phone: 541-556-4240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number087006822RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: