Healthcare Provider Details

I. General information

NPI: 1811686793
Provider Name (Legal Business Name): BETH SARAH CORLEY-GOLDBERG BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BETH SARAH GOLDBERG BSN, RN

II. Dates (important events)

Enumeration Date: 05/05/2023
Last Update Date: 01/26/2025
Certification Date: 01/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 19TH ST NW STE 150
WASHINGTON DC
20036-6103
US

IV. Provider business mailing address

21422 MIDSUMMER WAY
BROADLANDS VA
20148-5082
US

V. Phone/Fax

Practice location:
  • Phone: 202-293-5182
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberRN200001943
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: