Provider Demographics
NPI:1699969014
Name:RUSSEL, LAUREN (ND)
Entity type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:
Last Name:RUSSEL
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 1:20715 LARCH WAY APT 11
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-6854
Mailing Address - Country:US
Mailing Address - Phone:425-673-7350
Mailing Address - Fax:425-673-7350
Practice Address - Street 1:20715 LARCH WAY APT 11
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-6854
Practice Address - Country:US
Practice Address - Phone:425-673-7350
Practice Address - Fax:425-673-7350
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT00001583175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath