Provider Demographics
NPI:1124568506
Name:SHIVE, LAURA THOMPSON
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:THOMPSON
Last Name:SHIVE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 SILVER MAPLE CT
Mailing Address - Street 2:
Mailing Address - City:MOUNT WOLF
Mailing Address - State:PA
Mailing Address - Zip Code:17347-8905
Mailing Address - Country:US
Mailing Address - Phone:717-880-0904
Mailing Address - Fax:
Practice Address - Street 1:250 SILVER MAPLE CT
Practice Address - Street 2:
Practice Address - City:MOUNT WOLF
Practice Address - State:PA
Practice Address - Zip Code:17347-8905
Practice Address - Country:US
Practice Address - Phone:717-880-0904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-03
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula