Provider Demographics
NPI:1629272562
Name:LAROSA, HEATHER KATHLEEN (RN, IBCLC, RLC)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:KATHLEEN
Last Name:LAROSA
Suffix:
Gender:F
Credentials:RN, IBCLC, RLC
Other - Prefix:MISS
Other - First Name:HEATHER
Other - Middle Name:KATHLEEN
Other - Last Name:MCDONNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:415 TAYLOR AVE
Mailing Address - Street 2:
Mailing Address - City:EAST PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-5221
Mailing Address - Country:US
Mailing Address - Phone:631-776-9258
Mailing Address - Fax:
Practice Address - Street 1:415 TAYLOR AVE
Practice Address - Street 2:
Practice Address - City:EAST PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-5221
Practice Address - Country:US
Practice Address - Phone:631-776-9258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY527260163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant