Healthcare Provider Details

I. General information

NPI: 1184183402
Provider Name (Legal Business Name): LAURA FLOOD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TESSI FLOOD

II. Dates (important events)

Enumeration Date: 03/16/2019
Last Update Date: 03/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 ATLANTIC AVE APT 2
BROOKLYN NY
11201-6746
US

IV. Provider business mailing address

59 ATLANTIC AVE APT 2
BROOKLYN NY
11201-6746
US

V. Phone/Fax

Practice location:
  • Phone: 917-432-9624
  • Fax:
Mailing address:
  • Phone: 917-432-9624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-153099
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: