Provider Demographics
NPI:1629801873
Name:WOOD, LARA (RN IBCLC)
Entity type:Individual
Prefix:
First Name:LARA
Middle Name:
Last Name:WOOD
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 1:8923 ROSEWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:JESSUP
Mailing Address - State:MD
Mailing Address - Zip Code:20794-9589
Mailing Address - Country:US
Mailing Address - Phone:443-896-3619
Mailing Address - Fax:
Practice Address - Street 1:8923 ROSEWOOD WAY
Practice Address - Street 2:
Practice Address - City:JESSUP
Practice Address - State:MD
Practice Address - Zip Code:20794-9589
Practice Address - Country:US
Practice Address - Phone:443-896-3619
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR174823163WM0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn