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General NPI Number Information
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NPI Number | 1194132985
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Entity Type | Individual
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Provider Name | MELISSA ANNE KOCHUBA R.N, I.B.C.L.C
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Gender | Male
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Dates
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Enumeration Date | 07/14/2014
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Last Update Date | 12/17/2024
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Provider Practice Location Address
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Address Line | 12608 LAKE NORMANDY LN
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City | FAIRFAX
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State | VA
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Zip | 22030-7251
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Country | US
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Telephone | 516-993-3094
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Fax |
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Provider Business Mailing Address
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Address Line | 12608 LAKE NORMANDY LN
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City | FAIRFAX
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State | VA
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Zip | 22030-7251
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Country | US
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Telephone | 516-993-3094
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WL0100X
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Taxonomy Name | Lactation Consultant (Registered Nurse)
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License Number | 6171021
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 163WL0100X
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Taxonomy Name | Lactation Consultant (Registered Nurse)
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License Number | 617102-1
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License Number State | NY
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