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General NPI Number Information
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NPI Number | 1528804879
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Entity Type | Individual
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Provider Name | SUSAN BRYANT RN, IBCLC
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Gender | Female
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Dates
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Enumeration Date | 07/06/2024
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Last Update Date | 07/06/2024
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Provider Practice Location Address
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Address Line | 221 LONGWOOD AVE
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City | BOSTON
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State | MA
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Zip | 02115-5817
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Country | US
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Telephone | 617-525-4120
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Fax |
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Provider Business Mailing Address
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Address Line | 7 OLD HARMONY RD
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City | N SCITUATE
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State | RI
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Zip | 02857-1326
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Country | US
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Telephone | 401-451-0228
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Fax | 401-451-0228
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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 | 163WL0100X
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Taxonomy Name | Lactation Consultant (Registered Nurse)
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License Number | 133209
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License Number State | MA
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