Provider Demographics
NPI:1477926400
Name:WILLIAMS, LAURA (IBCLC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:WILLIAMS
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 1:33596 COMMUNITY COLLEGE DR
Mailing Address - Street 2:
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-9214
Mailing Address - Country:US
Mailing Address - Phone:907-630-0342
Mailing Address - Fax:
Practice Address - Street 1:250 HOSPITAL PL
Practice Address - Street 2:
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-7559
Practice Address - Country:US
Practice Address - Phone:907-714-4470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-13
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
L-82079174N00000X
240131-OB12374700000X
AKNUAA6602376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No374700000XNursing Service Related ProvidersTechnician
No376K00000XNursing Service Related ProvidersNurse's Aide