Provider Demographics
NPI:1497053730
Name:LARA, NAOMI (CNM)
Entity Type:Individual
Prefix:
First Name:NAOMI
Middle Name:
Last Name:LARA
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8587 MORGAN LN
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55347-1625
Mailing Address - Country:US
Mailing Address - Phone:267-918-3087
Mailing Address - Fax:
Practice Address - Street 1:2759 BELLVIEW DR
Practice Address - Street 2:
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-1308
Practice Address - Country:US
Practice Address - Phone:267-918-3087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-10
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN2458952367A00000X
374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No374J00000XNursing Service Related ProvidersDoula