Provider Demographics
NPI:1568156230
Name:MACLEOD, LARK
Entity Type:Individual
Prefix:
First Name:LARK
Middle Name:
Last Name:MACLEOD
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 1:4584 BLUEJAY AVE
Mailing Address - Street 2:
Mailing Address - City:CHEBOYGAN
Mailing Address - State:MI
Mailing Address - Zip Code:49721-8935
Mailing Address - Country:US
Mailing Address - Phone:231-818-1980
Mailing Address - Fax:
Practice Address - Street 1:4584 BLUEJAY AVE
Practice Address - Street 2:
Practice Address - City:CHEBOYGAN
Practice Address - State:MI
Practice Address - Zip Code:49721-8935
Practice Address - Country:US
Practice Address - Phone:231-818-1980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula