Provider Demographics
NPI:1578144978
Name:FISHER, LAUREN BETH (IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:BETH
Last Name:FISHER
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:MISS
Other - First Name:LAUREN
Other - Middle Name:BETH
Other - Last Name:TEMPLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:23211 MARSHALL ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-1425
Mailing Address - Country:US
Mailing Address - Phone:313-261-6124
Mailing Address - Fax:
Practice Address - Street 1:23211 MARSHALL ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-1425
Practice Address - Country:US
Practice Address - Phone:313-261-6124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-16
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
L-302800174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN