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General NPI Number Information
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NPI Number | 1346925476
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Entity Type | Individual
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Provider Name | LAURA MARIE LEWELLEN IBCLC
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Gender | Female
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Dates
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Enumeration Date | 06/16/2023
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Last Update Date | 06/16/2023
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Provider Practice Location Address
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Address Line | 3362 PARKLAND DR
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48322-1828
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Country | US
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Telephone | 248-425-0702
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Fax |
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Provider Business Mailing Address
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Address Line | 913 WHITE HOUSE DR
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City | HIGHLAND
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State | MI
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Zip | 48356-1665
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Country | US
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Telephone | 248-431-2588
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174N00000X
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Taxonomy Name | Lactation Consultant (Non-RN)
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License Number | 4704115816
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License Number State | MI
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