Healthcare Provider Details

I. General information

NPI: 1265786586
Provider Name (Legal Business Name): BETTY HANNAH GREENMAN IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2012
Last Update Date: 11/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11811 DANDELION LN
HOUSTON TX
77071-2608
US

IV. Provider business mailing address

11811 DANDELION LN
HOUSTON TX
77071-2608
US

V. Phone/Fax

Practice location:
  • Phone: 713-540-8692
  • Fax: 713-721-4373
Mailing address:
  • Phone: 713-540-8692
  • Fax: 713-721-4373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number11022018
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: