Individual
THEA N BOATSWAIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, RD
Contact information
Practice address
13800 COPPERMINE RD FL 123, HERNDON, VA 20171-6163
(202) 600-9826
Mailing address
13800 COPPERMINE RD FL 123, HERNDON, VA 20171-6163
(202) 600-9826
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
—
—
133NN1002X
Nutrition Education Nutritionist
—
—
133V00000X
Registered Dietitian
Primary
—
VA
Other
Enumeration date
01/09/2020
Last updated
12/18/2024
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