Healthcare Provider Details

I. General information

NPI: 1447664024
Provider Name (Legal Business Name): LAURA HIGHTOWER RN IBCLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2014
Last Update Date: 11/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 WASHINGTON ST 102
SAN FRANCISCO CA
94109-2958
US

IV. Provider business mailing address

1900 WASHINGTON ST 102
SAN FRANCISCO CA
94109-2958
US

V. Phone/Fax

Practice location:
  • Phone: 303-478-4884
  • Fax:
Mailing address:
  • Phone: 303-478-4884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-45570
License Number StateCA

VIII. Authorized Official

Name: LAURA ROSE HIGHTOWER
Title or Position: FOUNDER
Credential: RN IBCLC
Phone: 303-478-4884