Healthcare Provider Details

I. General information

NPI: 1427819846
Provider Name (Legal Business Name): HEATHER LAKEY RN, BSN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2024
Last Update Date: 01/22/2024
Certification Date: 01/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19610 EDGEMONT SQ
ASHBURN VA
20147-5265
US

IV. Provider business mailing address

440 MONTICELLO AVE STE 1802
NORFOLK VA
23510-2670
US

V. Phone/Fax

Practice location:
  • Phone: 571-253-8337
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-131780
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: