Provider Demographics
NPI:1699365155
Name:BECKER, LAURA NICOLE (IBCLC)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:NICOLE
Last Name:BECKER
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:778 FORDHAM RD
Mailing Address - Street 2:
Mailing Address - City:GROVETOWN
Mailing Address - State:GA
Mailing Address - Zip Code:30813-0400
Mailing Address - Country:US
Mailing Address - Phone:480-529-9872
Mailing Address - Fax:785-329-4564
Practice Address - Street 1:778 FORDHAM RD
Practice Address - Street 2:
Practice Address - City:GROVETOWN
Practice Address - State:GA
Practice Address - Zip Code:30813-0400
Practice Address - Country:US
Practice Address - Phone:480-529-9872
Practice Address - Fax:785-329-4564
Is Sole Proprietor?:No
Enumeration Date:2021-01-19
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COL-302700174N00000X
GAL-302700174N00000X
KSL-302700174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN