Provider Demographics
NPI:1518017227
Name:EMMONS, LAURA ELIZABETH (CNM, IBCLC)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:ELIZABETH
Last Name:EMMONS
Suffix:
Gender:F
Credentials:CNM, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 53
Mailing Address - Street 2:
Mailing Address - City:GARRETT PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20896
Mailing Address - Country:US
Mailing Address - Phone:617-922-5917
Mailing Address - Fax:
Practice Address - Street 1:11206 KENILWORTH AVENUE
Practice Address - Street 2:
Practice Address - City:GARRETT PARK
Practice Address - State:MD
Practice Address - Zip Code:20896
Practice Address - Country:US
Practice Address - Phone:617-922-5917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1016029367A00000X
MDL-89049163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2934898OtherCIGNA
MAAA12919OtherHPHC
MA0700622Medicaid
MAHV0305OtherBCBS
MA0700622Medicaid