Basic Information
| Provider Information | |||||||||
| NPI: | 1871135509 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILSON | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | ASHLEY | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | RN, IBCLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 464 | ||||||||
| Address2: | |||||||||
| City: | LISBON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3304241468 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 964 NORTH MARKET STREET | ||||||||
| Address2: | |||||||||
| City: | LISBON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3304241468 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/15/2019 | ||||||||
| LastUpdateDate: | 10/15/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WL0100X | L-34906 | OH | N | Nursing Service Providers | Registered Nurse | Lactation Consultant | 163W00000X | RN.323271 | OH | Y | Nursing Service Providers | Registered Nurse |
No ID Information.