Provider Demographics
NPI:1427549963
Name:PETTY, LINDSAY (RN, BSN, IBCLC)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:
Last Name:PETTY
Suffix:
Gender:F
Credentials:RN, BSN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7621A CARTERET RD
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-2020
Mailing Address - Country:US
Mailing Address - Phone:301-503-0739
Mailing Address - Fax:
Practice Address - Street 1:7621A CARTERET RD
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-2020
Practice Address - Country:US
Practice Address - Phone:301-503-0739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-21
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZL-135790163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant