Provider Demographics
NPI:1356078760
Name:FELLOWS, LAURA PASQUINI (IBCLC)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:PASQUINI
Last Name:FELLOWS
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6324 FAIRVIEW RD STE 435
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-3373
Mailing Address - Country:US
Mailing Address - Phone:980-302-8835
Mailing Address - Fax:
Practice Address - Street 1:6324 FAIRVIEW RD STE 435
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-3373
Practice Address - Country:US
Practice Address - Phone:980-302-8835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-05
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL-87385171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider