Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | 11128253 |
NPI | 1225375488 |
---|---|
Provider Name | Ms. Brandy J Hansen |
First Address | Bloomington, IL 61701-5048 |
Second Address | Bloomington, IL 61701-5048 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2013 |
Last Update Date | 08/01/2013 |