Healthcare Provider Details

I. General information

NPI: 1699067082
Provider Name (Legal Business Name): ANGELA KAREN BURTON IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2011
Last Update Date: 05/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 ORION CT
YORKTOWN VA
23693-2622
US

IV. Provider business mailing address

100 ORION CT
YORKTOWN VA
23693-2622
US

V. Phone/Fax

Practice location:
  • Phone: 757-876-5144
  • Fax: 757-766-1632
Mailing address:
  • Phone: 757-876-5144
  • Fax: 757-766-1632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: