Healthcare Provider Details

I. General information

NPI: 1376911370
Provider Name (Legal Business Name): LAWRIE BRUST RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2015
Last Update Date: 09/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 RIVERMONT AVE
LYNCHBURG VA
24503-2030
US

IV. Provider business mailing address

1901 TATE SPRINGS RD
LYNCHBURG VA
24501-1109
US

V. Phone/Fax

Practice location:
  • Phone: 434-200-5457
  • Fax:
Mailing address:
  • Phone: 434-200-5457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-14935
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: