Provider Demographics
NPI:1518746593
Name:HALE, LAURA EERNISSE (CPM, LM)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:EERNISSE
Last Name:HALE
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7302 BRIDGER HILL CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89139-0515
Mailing Address - Country:US
Mailing Address - Phone:907-385-7361
Mailing Address - Fax:
Practice Address - Street 1:7302 BRIDGER HILL CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89139-0515
Practice Address - Country:US
Practice Address - Phone:907-385-7361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-27
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY034176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty