Provider Demographics
NPI:1063844785
Name:ELSTON, LORA LONGINO (RNC, IBCLC)
Entity Type:Individual
Prefix:
First Name:LORA
Middle Name:LONGINO
Last Name:ELSTON
Suffix:
Gender:F
Credentials:RNC, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:378 BLACK SPRINGS RD NE
Mailing Address - Street 2:
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061-9005
Mailing Address - Country:US
Mailing Address - Phone:478-234-8012
Mailing Address - Fax:
Practice Address - Street 1:378 BLACK SPRINGS RD NE
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-9005
Practice Address - Country:US
Practice Address - Phone:478-234-8012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-05
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN212071163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant