Healthcare Provider Details

I. General information

NPI: 1477351088
Provider Name (Legal Business Name): LINDA BREDE CALLAHAN RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2025
Last Update Date: 03/07/2025
Certification Date: 03/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9558 18TH BAY ST
NORFOLK VA
23518-6224
US

IV. Provider business mailing address

9558 18TH BAY ST
NORFOLK VA
23518-6224
US

V. Phone/Fax

Practice location:
  • Phone: 804-334-2924
  • Fax:
Mailing address:
  • Phone: 804-334-2924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number1280359
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: