Provider Demographics
NPI:1205586989
Name:PASTULA, LAURA L (CERTIFIEDBIRTH DOULA)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:L
Last Name:PASTULA
Suffix:
Gender:F
Credentials:CERTIFIEDBIRTH DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 FARMS RD
Mailing Address - Street 2:
Mailing Address - City:BROAD BROOK
Mailing Address - State:CT
Mailing Address - Zip Code:06016-1409
Mailing Address - Country:US
Mailing Address - Phone:860-712-5834
Mailing Address - Fax:
Practice Address - Street 1:18 FARMS RD
Practice Address - Street 2:
Practice Address - City:BROAD BROOK
Practice Address - State:CT
Practice Address - Zip Code:06016-1409
Practice Address - Country:US
Practice Address - Phone:860-712-5834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-25
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4507374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty