Provider Demographics
NPI:1356786420
Name:WALL, LAUREN (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:WALL
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:PO BOX 3206
Mailing Address - Street 2:
Mailing Address - City:FRIDAY HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98250-3206
Mailing Address - Country:US
Mailing Address - Phone:360-370-5991
Mailing Address - Fax:
Practice Address - Street 1:43 GRANDVIEW LN
Practice Address - Street 2:
Practice Address - City:FRIDAY HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98250-8284
Practice Address - Country:US
Practice Address - Phone:360-370-5991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-02
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60334369163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant