Provider Demographics
NPI:1376917849
Name:ANNE, PRISCILLA (RN, IBCLC)
Entity Type:Individual
Prefix:MS
First Name:PRISCILLA
Middle Name:
Last Name:ANNE
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 1:7117 ITTE LN
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22150-3150
Mailing Address - Country:US
Mailing Address - Phone:703-403-6957
Mailing Address - Fax:
Practice Address - Street 1:7117 ITTE LN
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22150-3150
Practice Address - Country:US
Practice Address - Phone:703-403-6957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-21
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VARN0001244726163WM0102X
251E00000X
VA0001244726163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn
No251E00000XAgenciesHome Health