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General NPI Number Information
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NPI Number | 1346669785
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Entity Type | Individual
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Provider Name | AMY BOURNE IBCLC
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Gender | Female
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Dates
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Enumeration Date | 04/14/2014
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Last Update Date | 04/14/2014
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Provider Practice Location Address
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Address Line | 8233 DOCTOR CRAIK CT
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City | ALEXANDRIA
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State | VA
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Zip | 22306-3275
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Country | US
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Telephone | 703-401-5056
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Fax |
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Provider Business Mailing Address
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Address Line | 8233 DOCTOR CRAIK CT
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City | ALEXANDRIA
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State | VA
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Zip | 22306-3275
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Country | US
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Telephone | 703-401-5056
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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 | RN1010699
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License Number State | DC
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