Provider Demographics
NPI:1710138862
Name:NELSON, LAURA ELEANOR (LMP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ELEANOR
Last Name:NELSON
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6523 21ST AVE NE
Mailing Address - Street 2:#3
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-6924
Mailing Address - Country:US
Mailing Address - Phone:206-854-6141
Mailing Address - Fax:206-525-5176
Practice Address - Street 1:8530 54TH AVE NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-3910
Practice Address - Country:US
Practice Address - Phone:206-854-6141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-07
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60020048225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist