Provider Demographics
NPI:1356740195
Name:NATHAN, LAURA (LM, CPM)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:NATHAN
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2016 OAKHURST AVE
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-2510
Mailing Address - Country:US
Mailing Address - Phone:770-312-2093
Mailing Address - Fax:
Practice Address - Street 1:2016 OAKHURST AVE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-2510
Practice Address - Country:US
Practice Address - Phone:770-312-2093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-18
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMW295176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife