Provider Demographics
NPI:1932534732
Name:ANASTASI, LAURA CATHLEEN (DT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:CATHLEEN
Last Name:ANASTASI
Suffix:
Gender:F
Credentials:DT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1842 MOORE ST
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-2867
Mailing Address - Country:US
Mailing Address - Phone:608-362-1980
Mailing Address - Fax:
Practice Address - Street 1:1842 MOORE ST
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-2867
Practice Address - Country:US
Practice Address - Phone:608-362-1980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-11
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator