Provider Demographics
NPI:1861719759
Name:STATILE, LARA MERRILL (CD (DONA), RN)
Entity type:Individual
Prefix:MRS
First Name:LARA
Middle Name:MERRILL
Last Name:STATILE
Suffix:
Gender:F
Credentials:CD (DONA), RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10912 BRIMFIELD CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-7790
Mailing Address - Country:US
Mailing Address - Phone:919-413-7855
Mailing Address - Fax:
Practice Address - Street 1:10912 BRIMFIELD CT
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-7790
Practice Address - Country:US
Practice Address - Phone:919-413-7855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-30
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula