Provider Demographics
NPI:1659790640
Name:WILSON, LAUREN NEAL (ND, LMP)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:NEAL
Last Name:WILSON
Suffix:
Gender:M
Credentials:ND, LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2023 E SIMS WAY # 127
Mailing Address - Street 2:
Mailing Address - City:PORT TOWNSEND
Mailing Address - State:WA
Mailing Address - Zip Code:98368-6905
Mailing Address - Country:US
Mailing Address - Phone:360-900-1044
Mailing Address - Fax:
Practice Address - Street 1:1233 LAWRENCE ST STE 102
Practice Address - Street 2:
Practice Address - City:PORT TOWNSEND
Practice Address - State:WA
Practice Address - Zip Code:98368-6554
Practice Address - Country:US
Practice Address - Phone:360-900-1044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-07
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT60701877175F00000X
WA60345961225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist