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General NPI Number Information
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NPI Number | 1619855020
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Entity Type | Individual
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Provider Name | LISA BRADY RN, CLC
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Gender | Female
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Dates
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Enumeration Date | 08/25/2025
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Last Update Date | 08/25/2025
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Provider Practice Location Address
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Address Line | 6850 AUSTIN CENTER BLVD STE 225
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City | AUSTIN
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State | TX
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Zip | 78731-3293
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Country | US
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Telephone | 512-846-6455
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Fax |
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Provider Business Mailing Address
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Address Line | 1509 RUTH AVE
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City | AUSTIN
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State | TX
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Zip | 78757-2519
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Country | US
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Telephone | 512-230-4422
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Fax |
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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 | 810709
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License Number State | TX
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