Provider Demographics
NPI:1053158865
Name:CLARK-GRUBBS, LAURIE (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:CLARK-GRUBBS
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 MONTAGUE CIR
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-4425
Mailing Address - Country:US
Mailing Address - Phone:703-501-8983
Mailing Address - Fax:
Practice Address - Street 1:31 MONTAGUE CIR
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-4425
Practice Address - Country:US
Practice Address - Phone:703-501-8983
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001092828163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant