Healthcare Provider Details

I. General information

NPI: 1467378521
Provider Name (Legal Business Name): JASMINE WRENN RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8401 MAYLAND DR STE V
RICHMOND VA
23294-4648
US

IV. Provider business mailing address

8401 MAYLAND DR STE V
RICHMOND VA
23294-4648
US

V. Phone/Fax

Practice location:
  • Phone: 757-563-3641
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number0001280598
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: