Provider Demographics
NPI:1508201344
Name:BROCKHAUS, NATASHA ROSE (BS, IBCLC)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:ROSE
Last Name:BROCKHAUS
Suffix:
Gender:F
Credentials:BS, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2780 W CARR HILL RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-4984
Mailing Address - Country:US
Mailing Address - Phone:812-374-2746
Mailing Address - Fax:812-375-0949
Practice Address - Street 1:2780 W CARR HILL RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-4984
Practice Address - Country:US
Practice Address - Phone:812-374-2746
Practice Address - Fax:812-375-0949
Is Sole Proprietor?:No
Enumeration Date:2013-05-07
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN174400000X
11184180174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No174400000XOther Service ProvidersSpecialist