Healthcare Provider Details

I. General information

NPI: 1427857523
Provider Name (Legal Business Name): FLOURISH LACTATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2025
Last Update Date: 03/11/2025
Certification Date: 03/11/2025
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 Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State

VIII. Authorized Official

Name: KATARINA BERNICE WOROSELLO
Title or Position: LACTATION CONSULTANT
Credential:
Phone: 832-652-8620