Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 5794 | OR |
Y | 111NN1001X | Nutrition | 5794 | OR |
NPI | 1073050472 |
---|---|
Provider Name | Dr. Kirstin Marie Lauritzen |
First Address | Sherwood, OR 97140 |
Second Address | Wilsonville, OR 97070 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2017 |
Last Update Date | 24/07/2018 |