Provider Demographics
NPI:1275120792
Name:LA COUR-WORDLAW, NICOLE ATHENA
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:ATHENA
Last Name:LA COUR-WORDLAW
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 1:431 MANITOBA ST
Mailing Address - Street 2:
Mailing Address - City:PLAYA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90293-8011
Mailing Address - Country:US
Mailing Address - Phone:310-430-8010
Mailing Address - Fax:
Practice Address - Street 1:431 MANITOBA ST
Practice Address - Street 2:
Practice Address - City:PLAYA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90293-8011
Practice Address - Country:US
Practice Address - Phone:310-430-8010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-30
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0000374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula