MEDICARE: JESSICA TOWNSEND 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	163W00000X	Registered Nurse	0001259260	VA
2	163WL0100X	Lactation Consultant (Registered Nurse)	L-311556	CA

General Provider Information

NPI Number	:	1700608254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA TOWNSEND RN, IBCLC

Provider Business Mailing Address
First Line	:	5405 WILLCOXON TAVERN CT
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22032-2939
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5405 WILLCOXON TAVERN CT
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22032-2939
Country	:	US
Telephone Number	:	609-238-2726
Fax Number	:

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

Provider Enumeration Date	:	10/28/2024
Last Update Date	:	10/28/2024

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