Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | 316178 | VA |
NPI | 1366070344 |
---|---|
Provider Name | Racheal Marie Boyea-O'brien |
First Address | Portsmouth, VA 23703-1905 |
Second Address | Chesapeake, VA 23320-2628 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2020 |
Last Update Date | 27/03/2020 |