Provider Demographics
NPI:1811206196
Name:MISSEGHERS, LAURELEE MICHAELA (RD)
Entity Type:Individual
Prefix:
First Name:LAURELEE
Middle Name:MICHAELA
Last Name:MISSEGHERS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14858 LAKE HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-5809
Mailing Address - Country:US
Mailing Address - Phone:425-644-2808
Mailing Address - Fax:425-644-2682
Practice Address - Street 1:14858 LAKE HILLS BLVD
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-5809
Practice Address - Country:US
Practice Address - Phone:425-644-2808
Practice Address - Fax:425-644-2682
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-04
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANU60108299133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered