Individual
KATHLEEN NICOLE JENNINGS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, IBCLC
Contact information
Practice address
3600 JOSEPH SIEWICK DR, FAIRFAX, VA 22033-1709
(703) 391-3600
Mailing address
12602 JAMES BERGEN WAY, FAIRFAX, VA 22033-4382
(703) 655-5049
Taxonomy
Speciality
Code
Description
License number
State
163WL0100X
Lactation Consultant (Registered Nurse)
0001203763
VA
163WL0100X
Lactation Consultant (Registered Nurse)
Primary
L-19053
VA
Other
Enumeration date
08/31/2020
Last updated
08/31/2020
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