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General NPI Number Information
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NPI Number | 1437040474
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Entity Type | Individual
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Provider Name | LAURA STREET RN, BSN, IBCLC
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Gender | Female
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Dates
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Enumeration Date | 07/09/2025
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Last Update Date | 07/09/2025
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Provider Practice Location Address
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Address Line | 726 S MISSOURI AVE
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City | LAKELAND
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State | FL
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Zip | 33815-4738
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Country | US
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Telephone | 863-448-2224
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Fax |
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Provider Business Mailing Address
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Address Line | 182 HERITAGE PARK LN
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City | MULBERRY
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State | FL
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Zip | 33860-9447
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Country | US
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Telephone | 863-448-2224
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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 | 163WL0100X
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Taxonomy Name | Lactation Consultant (Registered Nurse)
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License Number | RN9460306
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License Number State | FL
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