Provider Demographics
NPI:1992172837
Name:ELIZABETH, LAURI (LAC)
Entity type:Individual
Prefix:
First Name:LAURI
Middle Name:
Last Name:ELIZABETH
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 1:5233 SW RICHENBERG CT
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-1262
Mailing Address - Country:US
Mailing Address - Phone:503-816-1443
Mailing Address - Fax:
Practice Address - Street 1:13505 SE RIVER RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97222-8097
Practice Address - Country:US
Practice Address - Phone:503-816-1443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-26
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10027885163W00000X
ORAC173876171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No163W00000XNursing Service ProvidersRegistered Nurse