MEDICARE: ALLISON BRYANE HARRISON CLC, MILC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174N00000X	Lactation Consultant (Non-RN)	345264

General Provider Information

NPI Number	:	1811699473
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLISON BRYANE HARRISON CLC, MILC

Provider Business Mailing Address
First Line	:	157 LACEY LN
Second Line	:
City	:	ANACOCO
State	:	LA
Zip	:	71403-3267
Country	:	US
Telephone Number	:	337-509-0261
Fax Number	:

Provider Business Practice Location Address
First Line	:	157 LACEY LN
Second Line	:
City	:	ANACOCO
State	:	LA
Zip	:	71403-3267
Country	:	US
Telephone Number	:	337-509-0261
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2023
Last Update Date	:	03/20/2023

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