MEDICARE: LAURA SLATER CPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	176B00000X	Midwife

General Provider Information

NPI Number	:	1801453428
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA SLATER CPM

Provider Business Mailing Address
First Line	:	2045 WEALTHY ST SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49506-3011
Country	:	US
Telephone Number	:	616-901-6378
Fax Number	:

Provider Business Practice Location Address
First Line	:	2045 WEALTHY ST SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49506-3011
Country	:	US
Telephone Number	:	616-901-6378
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2019
Last Update Date	:	05/20/2019

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Directions to “ LAURA SLATER CPM” Practice Location

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