Healthcare Provider Details

I. General information

NPI: 1811168719
Provider Name (Legal Business Name): JANE ELIZABETH BRADSHAW RN, IBCLC, RLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2008
Last Update Date: 03/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 OLD FOREST RD SUITE F
LYNCHBURG VA
24501-2335
US

IV. Provider business mailing address

2900 OLD FOREST RD SUITE F
LYNCHBURG VA
24501-2335
US

V. Phone/Fax

Practice location:
  • Phone: 434-384-6262
  • Fax:
Mailing address:
  • Phone: 434-384-6262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number0001075277
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: