Provider Demographics
NPI:1588962757
Name:SCRUGGS, LORAN (LAC)
Entity type:Individual
Prefix:
First Name:LORAN
Middle Name:
Last Name:SCRUGGS
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 1:914 WASHINGTON ST STE 5
Mailing Address - Street 2:
Mailing Address - City:PORT TOWNSEND
Mailing Address - State:WA
Mailing Address - Zip Code:98368-5746
Mailing Address - Country:US
Mailing Address - Phone:360-643-1096
Mailing Address - Fax:
Practice Address - Street 1:914 WASHINGTON ST STE 5
Practice Address - Street 2:
Practice Address - City:PORT TOWNSEND
Practice Address - State:WA
Practice Address - Zip Code:98368-5746
Practice Address - Country:US
Practice Address - Phone:360-643-1096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-11
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAX00002378171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist