Provider Demographics
NPI:1609475920
Name:WILLIAMS, LARA ANN (RN, BSN, IBCLC)
Entity Type:Individual
Prefix:
First Name:LARA
Middle Name:ANN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:RN, BSN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9222 SLOANE ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32827-7026
Mailing Address - Country:US
Mailing Address - Phone:512-762-2026
Mailing Address - Fax:
Practice Address - Street 1:8214 E ALEXANDER ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85708-1322
Practice Address - Country:US
Practice Address - Phone:512-762-2026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-19
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95216229163WL0100X
FL9497698163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant