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Individual

LAURA ANN WADSWORTH LUNDQUIST

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MSN, FNP-C, IBCLC

Contact information

Practice address
396 PHILBIN RD, POCATELLO, ID 83202-7071
(208) 241-1013
Mailing address
396 PHILBIN RD, POCATELLO, ID 83202-7071
(208) 241-1013

Taxonomy

Speciality
Code
Description
License number
State
163WL0100X
Lactation Consultant (Registered Nurse)
44334
ID
163WL0100X
Lactation Consultant (Registered Nurse)
Primary
N-44334
ID
363LF0000X
Family Nurse Practitioner
Primary
6081005
ID

Other

Enumeration date
08/21/2024
Last updated
04/29/2026
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