Provider Demographics
NPI:1750525424
Name:DERUITER, LAURA LYNNE (RN,IBCLC)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:LYNNE
Last Name:DERUITER
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 1:1809 N YOUNG RD
Mailing Address - Street 2:
Mailing Address - City:HART
Mailing Address - State:MI
Mailing Address - Zip Code:49420-8843
Mailing Address - Country:US
Mailing Address - Phone:231-873-3259
Mailing Address - Fax:231-873-8320
Practice Address - Street 1:1809 N YOUNG RD
Practice Address - Street 2:
Practice Address - City:HART
Practice Address - State:MI
Practice Address - Zip Code:49420-8843
Practice Address - Country:US
Practice Address - Phone:231-873-3259
Practice Address - Fax:231-873-8320
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-27
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704125868163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant