Healthcare Provider Details

I. General information

NPI: 1124517065
Provider Name (Legal Business Name): LAUREN DECUIR DAVID BSN, RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2018
Last Update Date: 05/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 JEFFERSON ST STE 900
LAFAYETTE LA
70501-8902
US

IV. Provider business mailing address

111 TRIPLE CROWN CIR
CARENCRO LA
70520-4319
US

V. Phone/Fax

Practice location:
  • Phone: 337-316-7354
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License NumberRN106612
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number11165697
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: