Provider Demographics
NPI:1821313644
Name:BRANNIGAN, MOLLY (IBCLC)
Entity Type:Individual
Prefix:MS
First Name:MOLLY
Middle Name:
Last Name:BRANNIGAN
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 1:828 SAN PABLO AVE
Mailing Address - Street 2:SUITE # 110
Mailing Address - City:ALBANY
Mailing Address - State:CA
Mailing Address - Zip Code:94706-1567
Mailing Address - Country:US
Mailing Address - Phone:510-847-2364
Mailing Address - Fax:
Practice Address - Street 1:828 SAN PABLO AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:ALBANY
Practice Address - State:CA
Practice Address - Zip Code:94706-1567
Practice Address - Country:US
Practice Address - Phone:510-847-2364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-05
Last Update Date:2012-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA108-46737174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN