Provider Demographics
NPI:1114740644
Name:BURKHEAD, EMILY NICOLE (IBCLC)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:NICOLE
Last Name:BURKHEAD
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7479 COLLINS MEADE WAY
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22315-5254
Mailing Address - Country:US
Mailing Address - Phone:443-752-6261
Mailing Address - Fax:
Practice Address - Street 1:1020 19TH ST NW STE 150
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-6103
Practice Address - Country:US
Practice Address - Phone:202-293-5182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAL-302713174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN