Provider Demographics
NPI:1073319422
Name:DUCKWORTH, LAURA (MSN, RN, IBCLC)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:DUCKWORTH
Suffix:
Gender:
Credentials:MSN, RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14517 MEADOWLAND CIR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:TX
Mailing Address - Zip Code:76071-9103
Mailing Address - Country:US
Mailing Address - Phone:817-793-1748
Mailing Address - Fax:
Practice Address - Street 1:14517 MEADOWLAND CIR
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:TX
Practice Address - Zip Code:76071-9103
Practice Address - Country:US
Practice Address - Phone:817-793-1748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX616345163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty