Provider Demographics
NPI:1235743154
Name:LAMAN, GRACE (RD LD)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:LAMAN
Suffix:
Gender:F
Credentials:RD LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 CHINOOK AVE
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:OR
Mailing Address - Zip Code:97103-5709
Mailing Address - Country:US
Mailing Address - Phone:503-410-0428
Mailing Address - Fax:
Practice Address - Street 1:10 PIER 1 STE 204
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-6328
Practice Address - Country:US
Practice Address - Phone:503-789-6850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered