Provider Demographics
NPI:1770007817
Name:DEFREESE, LAURA ELLEN (BS)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:ELLEN
Last Name:DEFREESE
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11768 WESTAR LN STE A
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98233-3672
Mailing Address - Country:US
Mailing Address - Phone:360-428-4270
Mailing Address - Fax:
Practice Address - Street 1:11768 WESTAR LANE, SUITE A
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98233
Practice Address - Country:US
Practice Address - Phone:360-428-4270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator