Individual
MRS. JESSICA BRUNOT BOULDIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CLC, CD
Contact information
Practice address
102 APACHE TRAIL, WINCHESTER, VA 22602-1300
(540) 222-8700
Mailing address
102 APACHE TRAIL, WINCHESTER, VA 22602-1300
(540) 222-8700
Taxonomy
Speciality
Code
Description
License number
State
174N00000X
Lactation Consultant (Non-RN)
Primary
351584
VA
374J00000X
Doula
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
81180
—
VA
Enumeration date
03/07/2023
Last updated
12/20/2023
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