Provider Demographics
NPI:1487075784
Name:BRANDENBURGER, LOUISA (IBCLC)
Entity type:Individual
Prefix:
First Name:LOUISA
Middle Name:
Last Name:BRANDENBURGER
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2906 MEYER AVE
Mailing Address - Street 2:
Mailing Address - City:GLENSIDE
Mailing Address - State:PA
Mailing Address - Zip Code:19038-1920
Mailing Address - Country:US
Mailing Address - Phone:215-921-1938
Mailing Address - Fax:
Practice Address - Street 1:2906 MEYER AVE
Practice Address - Street 2:
Practice Address - City:GLENSIDE
Practice Address - State:PA
Practice Address - Zip Code:19038-1920
Practice Address - Country:US
Practice Address - Phone:215-921-1938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-04
Last Update Date:2014-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA10915535174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN