Provider Demographics
NPI:1588334866
Name:JESSUP, MINH-TRI (IBCLC)
Entity type:Individual
Prefix:MRS
First Name:MINH-TRI
Middle Name:
Last Name:JESSUP
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 1:1820 S OAKLAND ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204-5139
Mailing Address - Country:US
Mailing Address - Phone:703-407-5068
Mailing Address - Fax:
Practice Address - Street 1:1020 19TH ST NW STE 120
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-6101
Practice Address - Country:US
Practice Address - Phone:202-293-5182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-17
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
L-301553174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN