Provider Demographics
NPI:1871922435
Name:KINDER, LAURA ROSE (RN, IBCLC)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:ROSE
Last Name:KINDER
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9728 N SAN RICARDO CT
Mailing Address - Street 2:
Mailing Address - City:WADDELL
Mailing Address - State:AZ
Mailing Address - Zip Code:85355-4430
Mailing Address - Country:US
Mailing Address - Phone:623-572-6681
Mailing Address - Fax:
Practice Address - Street 1:9728 N SAN RICARDO CT
Practice Address - Street 2:
Practice Address - City:WADDELL
Practice Address - State:AZ
Practice Address - Zip Code:85355-4430
Practice Address - Country:US
Practice Address - Phone:623-572-6681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN073255163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant