Healthcare Provider Details

I. General information

NPI: 1902678303
Provider Name (Legal Business Name): KATARINA WOROSELLO RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATARINA VAUGHN

II. Dates (important events)

Enumeration Date: 10/27/2023
Last Update Date: 10/27/2023
Certification Date: 10/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8200 RIVERSIDE RD
ALEXANDRIA VA
22308-1538
US

IV. Provider business mailing address

8200 RIVERSIDE RD
ALEXANDRIA VA
22308-1538
US

V. Phone/Fax

Practice location:
  • Phone: 832-652-8620
  • Fax:
Mailing address:
  • Phone: 832-652-8620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number0001294127
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: