Provider Demographics
NPI:1912575911
Name:LEBULE, LAURA AMIN
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:AMIN
Last Name:LEBULE
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 1:5702 SIGNET LN
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20737-3527
Mailing Address - Country:US
Mailing Address - Phone:240-484-9944
Mailing Address - Fax:
Practice Address - Street 1:5702 SIGNET LN
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737-3527
Practice Address - Country:US
Practice Address - Phone:240-484-9944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-15
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide