Provider Demographics
NPI:1497229793
Name:ROBERTS, VIRGINIA D (RN IBCLC)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:D
Last Name:ROBERTS
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 1:113 CURTISWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-5408
Mailing Address - Country:US
Mailing Address - Phone:615-496-5777
Mailing Address - Fax:
Practice Address - Street 1:2410 8TH AVE S
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37204-2490
Practice Address - Country:US
Practice Address - Phone:615-875-0875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-20
Last Update Date:2019-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNL-146177163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
L-146177OtherRN LACTATION CONSULTANT