Provider Demographics
NPI:1740471887
Name:EK-WATSON, LAURI MOSER (RD)
Entity type:Individual
Prefix:
First Name:LAURI
Middle Name:MOSER
Last Name:EK-WATSON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:LAURI
Other - Middle Name:MOSER
Other - Last Name:EK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:PO BOX 4105
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-4105
Mailing Address - Country:US
Mailing Address - Phone:866-907-1068
Mailing Address - Fax:425-917-9141
Practice Address - Street 1:3200 PROVIDENCE DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4615
Practice Address - Country:US
Practice Address - Phone:907-212-3046
Practice Address - Fax:907-212-4886
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK182133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered