Individual
DECOLA CUSTIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BSN, IBCLC
Contact information
Practice address
27457 BEACON RD, MELFA, VA 23410-3367
(757) 709-4444
Mailing address
27457 BEACON RD, MELFA, VA 23410-3367
(757) 709-4444
Taxonomy
Speciality
Code
Description
License number
State
163WL0100X
Lactation Consultant (Registered Nurse)
Primary
0001309544
VA
Other
Enumeration date
08/26/2024
Last updated
08/26/2024
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