Provider Demographics
NPI:1902678303
Name:WOROSELLO, KATARINA (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:KATARINA
Middle Name:
Last Name:WOROSELLO
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:KATARINA
Other - Middle Name:
Other - Last Name:VAUGHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8200 RIVERSIDE RD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22308-1538
Mailing Address - Country:US
Mailing Address - Phone:832-652-8620
Mailing Address - Fax:
Practice Address - Street 1:8200 RIVERSIDE RD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22308-1538
Practice Address - Country:US
Practice Address - Phone:832-652-8620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-27
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001294127163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant