Provider Demographics
NPI:1548623267
Name:BHISE, ASHWINI SUDHIR (PHD, IBCLC)
Entity type:Individual
Prefix:
First Name:ASHWINI
Middle Name:SUDHIR
Last Name:BHISE
Suffix:
Gender:F
Credentials:PHD, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6040 SHERIDAN DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47203-8506
Mailing Address - Country:US
Mailing Address - Phone:970-672-4667
Mailing Address - Fax:
Practice Address - Street 1:6040 SHERIDAN DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47203-8506
Practice Address - Country:US
Practice Address - Phone:970-672-4667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-30
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INL-49696174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN