Provider Demographics
NPI:1528300605
Name:PARKS, LAURA STAUFFER (LAC)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:STAUFFER
Last Name:PARKS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1671 W STERNS RD
Mailing Address - Street 2:D.
Mailing Address - City:TEMPERANCE
Mailing Address - State:MI
Mailing Address - Zip Code:48182-1586
Mailing Address - Country:US
Mailing Address - Phone:734-847-0909
Mailing Address - Fax:
Practice Address - Street 1:1671 W STERNS RD
Practice Address - Street 2:D.
Practice Address - City:TEMPERANCE
Practice Address - State:MI
Practice Address - Zip Code:48182-1586
Practice Address - Country:US
Practice Address - Phone:734-847-0909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-26
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01996171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist