| Doctor Name: | JUSTINA LEE BRENNER |
| NPI Number: | 1417318783 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RN, IBCLC |
| License Number: | L-17999 |
| Business Practice Address: | 6137 Green Rd Haslett, MI - 488409788 |
| Business Phone Number: | 5172824399 |
| Business Fax Number: | |
| Mailing Address: | 6137 Green Rd, HASLETT |
| State: | MI |
| Postal Code: | 488409788 |
| Phone Number: | 5172824399 |
| Fax Number: | |
| NPI Enumeration Date: | 03/15/2016 |
| NPI Last Update Date: | 03/15/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WL0100X |
| License Number: | L-17999 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MI |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Lactation Consultant |
| Taxonomy Definition: | |