Provider Demographics
NPI:1073657912
Name:LAURENSON, ELIZABETH A (ND)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:A
Last Name:LAURENSON
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:534 PLEASANT VIEW WAY NW
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-1789
Mailing Address - Country:US
Mailing Address - Phone:541-812-5656
Mailing Address - Fax:541-812-5660
Practice Address - Street 1:534 PLEASANT VIEW WAY NW
Practice Address - Street 2:SUITE 100
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-1789
Practice Address - Country:US
Practice Address - Phone:541-812-5656
Practice Address - Fax:541-812-5660
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0779175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR065891Medicaid