Provider Demographics
NPI:1235537234
Name:FIRETAG, LAURA ELAYNE (ND)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:ELAYNE
Last Name:FIRETAG
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:803 39TH AVE SW
Mailing Address - Street 2:SUITE F
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-3692
Mailing Address - Country:US
Mailing Address - Phone:253-848-1055
Mailing Address - Fax:844-724-2118
Practice Address - Street 1:803 39TH AVE SW
Practice Address - Street 2:SUITE F
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-3692
Practice Address - Country:US
Practice Address - Phone:253-848-1055
Practice Address - Fax:844-724-2118
Is Sole Proprietor?:No
Enumeration Date:2014-12-08
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT60524427175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath