Provider Demographics
NPI:1538653324
Name:WARE, KIMBERLY JOY (LPN,IBCLC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:JOY
Last Name:WARE
Suffix:
Gender:F
Credentials:LPN,IBCLC
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:JOY
Other - Last Name:MCNULTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN,IBCLC
Mailing Address - Street 1:42629 SMOKEY EMBERS TER
Mailing Address - Street 2:
Mailing Address - City:DULLES
Mailing Address - State:VA
Mailing Address - Zip Code:20166-2604
Mailing Address - Country:US
Mailing Address - Phone:571-276-0141
Mailing Address - Fax:
Practice Address - Street 1:19500 SANDRIDGE WAY STE 110
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-3689
Practice Address - Country:US
Practice Address - Phone:703-723-7337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-15
Last Update Date:2018-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAL-96892174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN