Provider Demographics
NPI:1407504970
Name:CHASTEEN, LAURA KATHLEEN (MS, CN)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:KATHLEEN
Last Name:CHASTEEN
Suffix:
Gender:F
Credentials:MS, CN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14040 15TH AVE NE APT 324E
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-8444
Mailing Address - Country:US
Mailing Address - Phone:919-749-9797
Mailing Address - Fax:
Practice Address - Street 1:14040 15TH AVE NE APT 324E
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-8444
Practice Address - Country:US
Practice Address - Phone:919-749-9797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-14
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANU61202793133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist