Healthcare Provider Details

I. General information

NPI: 1851631352
Provider Name (Legal Business Name): TAMMY ROCKWELL RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2013
Last Update Date: 02/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3319 FLOYD AVE
RICHMOND VA
23221-2905
US

IV. Provider business mailing address

3319 FLOYD AVE
RICHMOND VA
23221-2905
US

V. Phone/Fax

Practice location:
  • Phone: 804-512-0314
  • Fax:
Mailing address:
  • Phone: 804-512-0314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number0001163776
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: