Provider Demographics
NPI:1295523603
Name:WINDOM, LARA LEIGH (LPN)
Entity type:Individual
Prefix:
First Name:LARA
Middle Name:LEIGH
Last Name:WINDOM
Suffix:
Gender:
Credentials:LPN
Other - Prefix:
Other - First Name:LARALEIGH
Other - Middle Name:
Other - Last Name:FORESTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:514 W MAPLE ST STE 1206
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-2536
Mailing Address - Country:US
Mailing Address - Phone:770-844-7826
Mailing Address - Fax:
Practice Address - Street 1:514 W MAPLE ST STE 1206
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2536
Practice Address - Country:US
Practice Address - Phone:770-844-7826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-26
Last Update Date:2025-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN090617164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse