Provider Demographics
NPI:1144711284
Name:MUTH, MARJORIE ANNE (RN, BSN, IBCLC)
Entity type:Individual
Prefix:
First Name:MARJORIE
Middle Name:ANNE
Last Name:MUTH
Suffix:
Gender:F
Credentials:RN, BSN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23220-3720
Mailing Address - Country:US
Mailing Address - Phone:703-973-1473
Mailing Address - Fax:
Practice Address - Street 1:1130 WEST AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23220-3720
Practice Address - Country:US
Practice Address - Phone:703-973-1473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-24
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001081561163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
Provider Identifiers
StateIdentifier IDID TypeIssuer
163WLO100XOtherLACTATION CONSULTANT