Healthcare Provider Details

I. General information

NPI: 1598461717
Provider Name (Legal Business Name): MARY LAURA RICHARDSON MS, BA, RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2023
Last Update Date: 01/31/2023
Certification Date: 01/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5025 VISTA DEL SOL PT
COLORADO SPRINGS CO
80919-8007
US

IV. Provider business mailing address

5025 VISTA DEL SOL PT
COLORADO SPRINGS CO
80919-8007
US

V. Phone/Fax

Practice location:
  • Phone: 717-377-2568
  • Fax:
Mailing address:
  • Phone: 717-377-2568
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number1653683
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: