Healthcare Provider Details

I. General information

NPI: 1184189888
Provider Name (Legal Business Name): CYNTHIA BAULEY RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2019
Last Update Date: 02/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7829 GLENISTER DR
SPRINGFIELD VA
22152-2007
US

IV. Provider business mailing address

7829 GLENISTER DR
SPRINGFIELD VA
22152-2007
US

V. Phone/Fax

Practice location:
  • Phone: 703-569-6216
  • Fax:
Mailing address:
  • Phone: 703-569-6216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number0001196288
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: