Healthcare Provider Details

I. General information

NPI: 1265288229
Provider Name (Legal Business Name): CHARITY WASHINGTON RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2024
Last Update Date: 04/29/2024
Certification Date: 04/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 S KEENELAND DR
RICHMOND KY
40475-3279
US

IV. Provider business mailing address

130 WAR ADMIRAL APT 1
DANVILLE KY
40422-8693
US

V. Phone/Fax

Practice location:
  • Phone: 812-240-8797
  • Fax:
Mailing address:
  • Phone: 859-533-0145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number11134346
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: