Healthcare Provider Details

I. General information

NPI: 1013080035
Provider Name (Legal Business Name): LAURA ANN LAWSON C.N.M., W.H.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 01/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 FRANKLIN AVE SUITE 270
NORMAL IL
61761-3592
US

IV. Provider business mailing address

3110 FIONA WAY
BLOOMINGTON IL
61704-7011
US

V. Phone/Fax

Practice location:
  • Phone: 309-585-3535
  • Fax: 309-454-3554
Mailing address:
  • Phone: 309-585-3535
  • Fax: 309-454-3554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number209-005292
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: