Provider Demographics
NPI:1144686379
Name:NEVILLE, LAURA (ND)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:
Last Name:NEVILLE
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 1:5439 SE KNAPP ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-8240
Mailing Address - Country:US
Mailing Address - Phone:503-244-0500
Mailing Address - Fax:503-853-8615
Practice Address - Street 1:1340 SW BERTHA BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-2096
Practice Address - Country:US
Practice Address - Phone:503-244-0500
Practice Address - Fax:503-853-8615
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-04
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3068175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath