Healthcare Provider Details

I. General information

NPI: 1174298301
Provider Name (Legal Business Name): BREASTFEEDING OUTREACH FOR GREATER WASHINGTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2021
Last Update Date: 08/10/2021
Certification Date: 08/10/2021
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

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

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number
License Number State

VIII. Authorized Official

Name: KATHLEEN SHAMP
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 202-293-5182