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General NPI Number Information
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NPI Number | 1871882761
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Entity Type | Individual
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Provider Name | SUSAN LEA BREMMER IBCLC
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Gender | Female
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Dates
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Enumeration Date | 03/31/2011
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Last Update Date | 11/08/2024
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Provider Practice Location Address
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Address Line | 4678 N SWEET BAY LN
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86404-5401
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Country | US
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Telephone | 303-810-2669
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Fax |
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Provider Business Mailing Address
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Address Line | 4678 N SWEET BAY LN
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86404-5401
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Country | US
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Telephone | 303-810-2669
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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 | 174N00000X
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Taxonomy Name | Lactation Consultant (Non-RN)
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License Number | 10218781
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License Number State | CO
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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 | L-33965
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License Number State |
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