MEDICARE: MRS. JENNIFER ANNE BRADBURY RN, IBCLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WL0100X	Lactation Consultant (Registered Nurse)	L-36951	VA
2	163W00000X	Registered Nurse	0001161243	VA

General Provider Information

NPI Number	:	1144840505
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER ANNE BRADBURY RN, IBCLC

Provider Business Mailing Address
First Line	:	4723 GAINSBOROUGH DR
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22032-2380
Country	:	US
Telephone Number	:	240-314-9507
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 N WASHINGTON ST STE 300
Second Line	:
City	:	FALLS CHURCH
State	:	VA
Zip	:	22046-3514
Country	:	US
Telephone Number	:	703-517-1436
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2020
Last Update Date	:	01/16/2026

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