Provider Demographics
NPI:1265250229
Name:VARGHESE, LAURA (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:VARGHESE
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 REVERE RD
Mailing Address - Street 2:
Mailing Address - City:ARDSLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10502-1226
Mailing Address - Country:US
Mailing Address - Phone:973-270-4650
Mailing Address - Fax:
Practice Address - Street 1:46 REVERE RD
Practice Address - Street 2:
Practice Address - City:ARDSLEY
Practice Address - State:NY
Practice Address - Zip Code:10502-1226
Practice Address - Country:US
Practice Address - Phone:973-270-4650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY614024163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant