Provider Demographics
NPI:1093296006
Name:MOURINO, LAURA STEPHANIE (ND)
Entity Type:Individual
Prefix:MISS
First Name:LAURA
Middle Name:STEPHANIE
Last Name:MOURINO
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6956 SW HAMPTON ST
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8351
Mailing Address - Country:US
Mailing Address - Phone:216-707-9137
Mailing Address - Fax:
Practice Address - Street 1:6956 SW HAMPTON ST
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8351
Practice Address - Country:US
Practice Address - Phone:216-707-9137
Practice Address - Fax:216-707-0162
Is Sole Proprietor?:No
Enumeration Date:2018-08-27
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4189175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath