Provider Demographics
NPI:1245053388
Name:VANARSDALE, BRENDA (BSN RN IBCLC)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:VANARSDALE
Suffix:
Gender:F
Credentials:BSN RN IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:HUXLEY
Mailing Address - State:IA
Mailing Address - Zip Code:50124-9443
Mailing Address - Country:US
Mailing Address - Phone:507-383-7536
Mailing Address - Fax:
Practice Address - Street 1:307 E 1ST ST
Practice Address - Street 2:
Practice Address - City:HUXLEY
Practice Address - State:IA
Practice Address - Zip Code:50124-9443
Practice Address - Country:US
Practice Address - Phone:507-383-7536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-06
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA152599163W00000X
IAL-312777163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163W00000XNursing Service ProvidersRegistered Nurse