Provider Demographics
NPI:1194132985
Name:KOCHUBA, MELISSA ANNE (RN, IBCLC)
Entity type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:ANNE
Last Name:KOCHUBA
Suffix:
Gender:M
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12608 LAKE NORMANDY LN
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-7251
Mailing Address - Country:US
Mailing Address - Phone:516-993-3094
Mailing Address - Fax:
Practice Address - Street 1:12608 LAKE NORMANDY LN
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-7251
Practice Address - Country:US
Practice Address - Phone:516-993-3094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-14
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6171021163WL0100X
NY617102-1163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant