Provider Demographics
NPI:1861886947
Name:WHITE, LAURA (RN, BSN, IBCLC)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:RN, BSN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-3317
Mailing Address - Country:US
Mailing Address - Phone:860-620-7087
Mailing Address - Fax:
Practice Address - Street 1:130 SKYLINE DR
Practice Address - Street 2:
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489-3317
Practice Address - Country:US
Practice Address - Phone:860-620-7087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-26
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTL-35395163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant