Provider Demographics
NPI:1710138862
Name:NELSON, LAURA ELEANOR (LMP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ELEANOR
Last Name:NELSON
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1317 E FAIRBANKS ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98404-3809
Mailing Address - Country:US
Mailing Address - Phone:206-854-6141
Mailing Address - Fax:
Practice Address - Street 1:4208 LEARY WAY NW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-4535
Practice Address - Country:US
Practice Address - Phone:206-854-6141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-07
Last Update Date:2025-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
A-3888947171400000X
WAMA 60020048225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No171400000XOther Service ProvidersHealth & Wellness Coach