Provider Demographics
NPI:1669977583
Name:HAMPTON ROADS LACTATION, LLC
Entity type:Organization
Organization Name:HAMPTON ROADS LACTATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LACTATION CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:TOBOLA
Authorized Official - Suffix:
Authorized Official - Credentials:RN, IBCLC
Authorized Official - Phone:757-598-4818
Mailing Address - Street 1:5106 W CREEK CT
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-3523
Mailing Address - Country:US
Mailing Address - Phone:757-598-4818
Mailing Address - Fax:757-610-9395
Practice Address - Street 1:5106 W CREEK CT
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-3523
Practice Address - Country:US
Practice Address - Phone:757-598-4818
Practice Address - Fax:757-610-9395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-25
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1257572163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1841708211OtherNPI 1