Healthcare Provider Details

I. General information

NPI: 1164341707
Provider Name (Legal Business Name): LAURA WILSON RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

242 HIGHWAY 87
ELDON MO
65026-4132
US

IV. Provider business mailing address

PO BOX 468
ELDON MO
65026-0468
US

V. Phone/Fax

Practice location:
  • Phone: 573-280-6566
  • Fax:
Mailing address:
  • Phone: 573-208-6566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number2002015901
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: