Healthcare Provider Details

I. General information

NPI: 1881501864
Provider Name (Legal Business Name): MATRESCENCE LACTATION AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

712 ANGEL WING DR
CHESAPEAKE VA
23323-4074
US

IV. Provider business mailing address

712 ANGEL WING DR
CHESAPEAKE VA
23323-4074
US

V. Phone/Fax

Practice location:
  • Phone: 619-823-0729
  • Fax:
Mailing address:
  • Phone: 619-823-0729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JESSICA DIANE SCHAFER
Title or Position: OWNER/NP
Credential: FNP
Phone: 619-823-0729