Healthcare Provider Details

I. General information

NPI: 1811358203
Provider Name (Legal Business Name): LORI L SCHUBERT RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2016
Last Update Date: 03/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 EAST ST SE SUITE 301
VIENNA VA
22180-4800
US

IV. Provider business mailing address

100 EAST STREET SE SUITE 301
VIENNA VA
22180
US

V. Phone/Fax

Practice location:
  • Phone: 703-938-5555
  • Fax:
Mailing address:
  • Phone: 703-938-5555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number0001159231
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: