Healthcare Provider Details

I. General information

NPI: 1700608254
Provider Name (Legal Business Name): JESSICA TOWNSEND RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2024
Last Update Date: 10/28/2024
Certification Date: 10/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5405 WILLCOXON TAVERN CT
FAIRFAX VA
22032-2939
US

IV. Provider business mailing address

5405 WILLCOXON TAVERN CT
FAIRFAX VA
22032-2939
US

V. Phone/Fax

Practice location:
  • Phone: 609-238-2726
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001259260
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-311556
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: