Provider Demographics
NPI:1407272750
Name:LOUDOUN LACTATION INC.
Entity Type:Organization
Organization Name:LOUDOUN LACTATION INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUNDAGE
Authorized Official - Suffix:
Authorized Official - Credentials:RN, IBCLC, RLC
Authorized Official - Phone:703-723-6621
Mailing Address - Street 1:43768 JENKINS LN
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-4822
Mailing Address - Country:US
Mailing Address - Phone:703-723-6621
Mailing Address - Fax:
Practice Address - Street 1:43768 JENKINS LN
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-4822
Practice Address - Country:US
Practice Address - Phone:703-723-6621
Practice Address - Fax:703-723-7877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-11
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001172419163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty