Provider Demographics
NPI:1366854242
Name:WILSON, LAUREL (IBCLC)
Entity Type:Individual
Prefix:
First Name:LAUREL
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22095 COOK LN
Mailing Address - Street 2:
Mailing Address - City:MORRISON
Mailing Address - State:CO
Mailing Address - Zip Code:80465-2548
Mailing Address - Country:US
Mailing Address - Phone:720-291-9115
Mailing Address - Fax:
Practice Address - Street 1:22095 COOK LN
Practice Address - Street 2:
Practice Address - City:MORRISON
Practice Address - State:CO
Practice Address - Zip Code:80465-2548
Practice Address - Country:US
Practice Address - Phone:720-291-9115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-27
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN