Provider Demographics
NPI:1871882761
Name:BREMMER, SUSAN LEA (IBCLC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:LEA
Last Name:BREMMER
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 1:4678 N SWEET BAY LN
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86404-5401
Mailing Address - Country:US
Mailing Address - Phone:303-810-2669
Mailing Address - Fax:
Practice Address - Street 1:4678 N SWEET BAY LN
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86404-5401
Practice Address - Country:US
Practice Address - Phone:303-810-2669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-31
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10218781174N00000X
L-33965174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN