Healthcare Provider Details

I. General information

NPI: 1265949093
Provider Name (Legal Business Name): AMY MUNSELL VALENZUELA RN, BSN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY MARIE MUNSELL RN, BSN

II. Dates (important events)

Enumeration Date: 01/02/2018
Last Update Date: 01/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14139 POTOMAC MILLS RD
WOODBRIDGE VA
22192-4644
US

IV. Provider business mailing address

14139 POTOMAC MILLS RD
WOODBRIDGE VA
22192-4644
US

V. Phone/Fax

Practice location:
  • Phone: 703-490-7765
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-100498
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: