Provider Demographics
NPI:1184189888
Name:BAULEY, CYNTHIA (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:BAULEY
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7829 GLENISTER DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22152-2007
Mailing Address - Country:US
Mailing Address - Phone:703-569-6216
Mailing Address - Fax:
Practice Address - Street 1:7829 GLENISTER DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22152-2007
Practice Address - Country:US
Practice Address - Phone:703-569-6216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-06
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001196288163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant