Provider Demographics
NPI:1649907957
Name:BOOREN, BREANNE (IBCLC)
Entity type:Individual
Prefix:
First Name:BREANNE
Middle Name:
Last Name:BOOREN
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:BRE
Other - Middle Name:
Other - Last Name:BOOREN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:IBCLC
Mailing Address - Street 1:13164 OLD SYCAMORE DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-4043
Mailing Address - Country:US
Mailing Address - Phone:303-525-8138
Mailing Address - Fax:
Practice Address - Street 1:13164 OLD SYCAMORE DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-4043
Practice Address - Country:US
Practice Address - Phone:303-525-8138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-05
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
L126580174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN