Provider Demographics
NPI:1427300862
Name:MIELE, LAURIE
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:MIELE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 45
Mailing Address - Street 2:
Mailing Address - City:BENSON
Mailing Address - State:MD
Mailing Address - Zip Code:21018-0045
Mailing Address - Country:US
Mailing Address - Phone:410-989-1014
Mailing Address - Fax:
Practice Address - Street 1:108 CONNOLLY RD
Practice Address - Street 2:
Practice Address - City:BENSON
Practice Address - State:MD
Practice Address - Zip Code:21018-2500
Practice Address - Country:US
Practice Address - Phone:410-989-1014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-09
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR109234163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant