Provider Demographics
NPI:1174731301
Name:O'HARA-BRILL, SUSAN R (IBCLC, RLC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:R
Last Name:O'HARA-BRILL
Suffix:
Gender:F
Credentials:IBCLC, RLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 HIDDEN VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27516-8949
Mailing Address - Country:US
Mailing Address - Phone:919-423-8943
Mailing Address - Fax:919-967-6928
Practice Address - Street 1:113 HIDDEN VALLEY DR
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27516-8949
Practice Address - Country:US
Practice Address - Phone:919-423-8943
Practice Address - Fax:919-967-6928
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC100-16735174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC100-16735OtherREGISTERED LACTATION CONS