Provider Demographics
NPI:1366885758
Name:OBERHOLSER, LAUREN FAYE (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:FAYE
Last Name:OBERHOLSER
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 1:5812 GOLIAD ST NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-5410
Mailing Address - Country:US
Mailing Address - Phone:505-280-9254
Mailing Address - Fax:
Practice Address - Street 1:7708 4TH ST NW
Practice Address - Street 2:
Practice Address - City:LOS RANCHOS
Practice Address - State:NM
Practice Address - Zip Code:87107-6510
Practice Address - Country:US
Practice Address - Phone:505-924-2229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-16
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRN-70078163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant