Provider Demographics
NPI:1275157604
Name:ST CLAIR, LAURALEE
Entity Type:Individual
Prefix:
First Name:LAURALEE
Middle Name:
Last Name:ST CLAIR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35398 S DICKEY PRAIRIE RD
Mailing Address - Street 2:
Mailing Address - City:MOLALLA
Mailing Address - State:OR
Mailing Address - Zip Code:97038-8627
Mailing Address - Country:US
Mailing Address - Phone:971-678-8956
Mailing Address - Fax:
Practice Address - Street 1:35398 S DICKEY PRAIRIE RD
Practice Address - Street 2:
Practice Address - City:MOLALLA
Practice Address - State:OR
Practice Address - Zip Code:97038-8627
Practice Address - Country:US
Practice Address - Phone:971-678-8956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-01
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200541700RN163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health