Provider Demographics
NPI:1619320777
Name:BRUNOW, MADELYN LEE (RNC, IBCLC, RLC)
Entity Type:Individual
Prefix:MRS
First Name:MADELYN
Middle Name:LEE
Last Name:BRUNOW
Suffix:
Gender:F
Credentials:RNC, IBCLC, RLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3539 230TH ST
Mailing Address - Street 2:
Mailing Address - City:WOODBINE
Mailing Address - State:IA
Mailing Address - Zip Code:51579-5064
Mailing Address - Country:US
Mailing Address - Phone:712-592-9814
Mailing Address - Fax:
Practice Address - Street 1:3539 230TH ST
Practice Address - Street 2:
Practice Address - City:WOODBINE
Practice Address - State:IA
Practice Address - Zip Code:51579-5064
Practice Address - Country:US
Practice Address - Phone:712-592-9814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-13
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA102605163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant