Provider Demographics
NPI:1093013161
Name:ST.LAWRENCE, HOLLY RAE (NTP, CPT, CFG)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:RAE
Last Name:ST.LAWRENCE
Suffix:
Gender:F
Credentials:NTP, CPT, CFG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:566 HORN LN
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97404-2961
Mailing Address - Country:US
Mailing Address - Phone:541-636-3856
Mailing Address - Fax:
Practice Address - Street 1:566 HORN LN
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97404-2961
Practice Address - Country:US
Practice Address - Phone:541-636-3856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-14
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA0800133VN1006X
CA1344664172M00000X
OR656619175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
No172M00000XOther Service ProvidersMechanotherapist
No175F00000XOther Service ProvidersNaturopath