Provider Demographics
NPI:1710673025
Name:BREUGEM, JOANNA (IBCLC)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:BREUGEM
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 1:590 A CIR
Mailing Address - Street 2:
Mailing Address - City:PINE MOUNTAIN VALLEY
Mailing Address - State:GA
Mailing Address - Zip Code:31823-3613
Mailing Address - Country:US
Mailing Address - Phone:209-535-3075
Mailing Address - Fax:
Practice Address - Street 1:590 A CIR
Practice Address - Street 2:
Practice Address - City:PINE MOUNTAIN VALLEY
Practice Address - State:GA
Practice Address - Zip Code:31823-3613
Practice Address - Country:US
Practice Address - Phone:209-535-3075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-11
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAL-301275163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant