Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 209-005292 | IL |
NPI | 1013080035 |
---|---|
Provider Name | Mrs. Laura Ann Lawson |
First Address | Bloomington, IL 61704-7011 |
Second Address | Normal, IL 61761-3592 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2006 |
Last Update Date | 28/01/2016 |