Provider Demographics
NPI:1356968663
Name:LAURENT, DIANA NICHOLE (RN IBCLC)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:NICHOLE
Last Name:LAURENT
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 1:712 LAZY ST
Mailing Address - Street 2:
Mailing Address - City:TOOL
Mailing Address - State:TX
Mailing Address - Zip Code:75143-1576
Mailing Address - Country:US
Mailing Address - Phone:903-603-8358
Mailing Address - Fax:
Practice Address - Street 1:3201 W HIGHWAY 22
Practice Address - Street 2:
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75110-2450
Practice Address - Country:US
Practice Address - Phone:903-654-4300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-02
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL-149075163WL0100X
TX754141163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Multi-Specialty