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General NPI Number Information
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NPI Number | 1780069906
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Entity Type | Organization
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Legal Business Name | BESTFEEDING LACTATION SERVICES, LLC
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Dates
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Enumeration Date | 07/29/2015
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Last Update Date | 07/29/2015
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Provider Practice Location Address
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Address Line | 1533 BLUE RIDGE RD
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City | CHESAPEAKE
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State | VA
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Zip | 23322-1703
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Country | US
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Telephone | 757-944-1234
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Fax |
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Provider Business Mailing Address
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Address Line | 1533 BLUE RIDGE RD
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City | CHESAPEAKE
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State | VA
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Zip | 23322-1703
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | STACY KUCHARCZK
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Credential | CPNP
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Telephone | 757-944-1234
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 0024142347
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License Number State | VA
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