Healthcare Provider Details

I. General information

NPI: 1518426816
Provider Name (Legal Business Name): EMILY BENDER RN/BSN IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2019
Last Update Date: 03/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4781 BACK MOUNTAIN RD
WINCHESTER VA
22602-3462
US

IV. Provider business mailing address

4781 BACK MOUNTAIN RD
WINCHESTER VA
22602-3462
US

V. Phone/Fax

Practice location:
  • Phone: 540-305-6479
  • Fax:
Mailing address:
  • Phone: 540-305-6479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number0001231206
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: