Provider Demographics
NPI:1053018630
Name:EAVES, LAUREN A (PHD IBCLC)
Entity type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:A
Last Name:EAVES
Suffix:
Gender:F
Credentials:PHD IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1234 BERKELEY ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-3531
Mailing Address - Country:US
Mailing Address - Phone:919-904-0273
Mailing Address - Fax:
Practice Address - Street 1:5317 HIGHGATE DR STE 115
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-6622
Practice Address - Country:US
Practice Address - Phone:919-864-8361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-14
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
L-308286174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
Provider Identifiers
StateIdentifier IDID TypeIssuer
L-308286OtherINTERNATIONAL BOARD CERTIFIED LACTATION CONSULTANT