Provider Demographics
NPI:1851927180
Name:MULCAHY, LAURA BETH (CNM)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:BETH
Last Name:MULCAHY
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2023 VADALABENE DR
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62062-5630
Mailing Address - Country:US
Mailing Address - Phone:618-288-7408
Mailing Address - Fax:618-288-7418
Practice Address - Street 1:2023 VADALABENE DR STE 200
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62062-5636
Practice Address - Country:US
Practice Address - Phone:618-288-7408
Practice Address - Fax:618-288-7418
Is Sole Proprietor?:No
Enumeration Date:2020-03-18
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO176B00000X
MO2020009853367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No176B00000XOther Service ProvidersMidwife