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NPI Code Detail

MEDICARE: LAURA COULTER CNM/APN, MS, IBCLC

MEDICARE: LAURA COULTER CNM/APN, MS, IBCLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1367A00000XAdvanced Practice Midwife209-003413IL
2163WL0100XLactation Consultant (Registered Nurse)041-291976IL

General Provider Information

NPI Number : 1629218227
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAURA COULTER CNM/APN, MS, IBCLC
Provider Business Mailing Address
First Line : 4538 N HERMITAGE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60640-5304
Country : US
Telephone Number : 312-320-3996
Fax Number :
Provider Business Practice Location Address
First Line : 4538 N HERMITAGE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60640-5304
Country : US
Telephone Number : 312-320-3996
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/23/2009
Last Update Date : 05/11/2015

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