Provider Demographics
NPI:1881141414
Name:QUEZADA, MARGARET (BSN, RN, IBCLC)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:
Last Name:QUEZADA
Suffix:
Gender:F
Credentials:BSN, RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13610 PENNSBORO DR
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151-2718
Mailing Address - Country:US
Mailing Address - Phone:703-517-6158
Mailing Address - Fax:
Practice Address - Street 1:13610 PENNSBORO DR
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-2718
Practice Address - Country:US
Practice Address - Phone:703-517-6158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAL-68108163WL0100X
VA0001231579163WM0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn