Provider Demographics
NPI:1780088567
Name:KEOGH, LAURA J (RN)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:J
Last Name:KEOGH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 SW CRESTVIEW ST
Mailing Address - Street 2:
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163-2042
Mailing Address - Country:US
Mailing Address - Phone:509-334-5439
Mailing Address - Fax:509-332-0731
Practice Address - Street 1:850 SW CRESTVIEW ST
Practice Address - Street 2:
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163-2042
Practice Address - Country:US
Practice Address - Phone:509-334-5439
Practice Address - Fax:509-332-0731
Is Sole Proprietor?:No
Enumeration Date:2014-10-22
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA10877310163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAL-22219OtherIBCLC