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General NPI Number Information
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NPI Number | 1750525424
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Entity Type | Individual
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Provider Name | LAURA LYNNE DERUITER RN,IBCLC
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Gender | Female
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Dates
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Enumeration Date | 04/27/2009
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Last Update Date | 04/27/2009
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Provider Practice Location Address
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Address Line | 1809 N YOUNG RD
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City | HART
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State | MI
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Zip | 49420-8843
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Country | US
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Telephone | 231-873-3259
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Fax | 231-873-8320
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Provider Business Mailing Address
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Address Line | 1809 N YOUNG RD
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City | HART
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State | MI
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Zip | 49420-8843
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Country | US
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Telephone | 231-873-3259
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Fax | 231-873-8320
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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 | 4704125868
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License Number State | MI
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