Healthcare Provider Details

I. General information

NPI: 1598244147
Provider Name (Legal Business Name): RACHEL BOSTJANICK RN, BSN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2018
Last Update Date: 08/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7402 FLEMINGWOOD LN
SPRINGFIELD VA
22153-1701
US

IV. Provider business mailing address

4621 RANDOLPH DR
ANNANDALE VA
22003-6218
US

V. Phone/Fax

Practice location:
  • Phone: 703-425-2229
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberRN1035100
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number0001253877
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: