Individual
BRANDY DIANE RICHARDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CLC
Contact information
Practice address
561 DUTTON DR, PAGOSA SPRINGS, CO 81147-9307
(918) 541-6288
Mailing address
561 DUTTON DR, PAGOSA SPRINGS, CO 81147-9307
(918) 541-6288
Taxonomy
Speciality
Code
Description
License number
State
174N00000X
Lactation Consultant (Non-RN)
Primary
255464
CO
Other
Enumeration date
10/24/2019
Last updated
10/24/2019
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