Provider Demographics
NPI:1912066432
Name:STAVER, LAURA O'NEAL (ND)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:O'NEAL
Last Name:STAVER
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:628 NW YORK DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-1572
Mailing Address - Country:US
Mailing Address - Phone:541-388-2207
Mailing Address - Fax:541-388-2439
Practice Address - Street 1:628 NW YORK DR
Practice Address - Street 2:SUITE 104
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-1572
Practice Address - Country:US
Practice Address - Phone:541-388-2207
Practice Address - Fax:541-388-2439
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1413175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath