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General NPI Number Information
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NPI Number | 1508201344
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Entity Type | Individual
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Provider Name | NATASHA ROSE BROCKHAUS B.S., IBCLC
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Gender | Female
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Dates
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Enumeration Date | 05/07/2013
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Last Update Date | 05/07/2013
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Provider Practice Location Address
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Address Line | 2780 W CARR HILL RD
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City | COLUMBUS
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State | IN
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Zip | 47201-4984
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Country | US
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Telephone | 812-374-2746
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Fax | 812-375-0949
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Provider Business Mailing Address
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Address Line | 2780 W CARR HILL RD
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City | COLUMBUS
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State | IN
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Zip | 47201-4984
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Country | US
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Telephone | 812-374-2746
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Fax | 812-375-0949
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 174N00000X
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Taxonomy Name | Lactation Consultant (Non-RN)
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License Number | 11184180
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License Number State |
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