Provider Demographics
NPI:1932477056
Name:BRANSOME, INA Z (IBCLC)
Entity Type:Individual
Prefix:
First Name:INA
Middle Name:Z
Last Name:BRANSOME
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 1:513 HENRY ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11231-3175
Mailing Address - Country:US
Mailing Address - Phone:718-522-5380
Mailing Address - Fax:888-565-3930
Practice Address - Street 1:513 HENRY ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11231-3175
Practice Address - Country:US
Practice Address - Phone:646-708-5427
Practice Address - Fax:888-565-3930
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-03
Last Update Date:2011-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN