MEDICARE: GABRIELLE INCORVAIA 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)	0001245768	VA

General Provider Information

NPI Number	:	1194664193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GABRIELLE INCORVAIA RN, IBCLC

Provider Business Mailing Address
First Line	:	8018 HARTRIDGE DR
Second Line	:
City	:	CHESTERFIELD
State	:	VA
Zip	:	23832-2124
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8018 HARTRIDGE DR
Second Line	:
City	:	CHESTERFIELD
State	:	VA
Zip	:	23832-2124
Country	:	US
Telephone Number	:	973-714-1304
Fax Number	:	973-714-1304

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

Provider Enumeration Date	:	03/25/2026
Last Update Date	:	03/25/2026

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