Provider Demographics
NPI:1720823750
Name:MCLEOD, THERESA ANN (RN IBCLC)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:ANN
Last Name:MCLEOD
Suffix:
Gender:F
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 1:116 ALLEN HARRIS DR
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23692-4100
Mailing Address - Country:US
Mailing Address - Phone:757-218-8349
Mailing Address - Fax:
Practice Address - Street 1:116 ALLEN HARRIS DR
Practice Address - Street 2:
Practice Address - City:YORKTOWN
Practice Address - State:VA
Practice Address - Zip Code:23692-4100
Practice Address - Country:US
Practice Address - Phone:757-218-8349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001265446163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant