Healthcare Provider Details

I. General information

NPI: 1396451613
Provider Name (Legal Business Name): LAURA DEMERI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2023
Last Update Date: 01/30/2023
Certification Date: 01/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3704 MURPHY RD
NASHVILLE TN
37209-4906
US

IV. Provider business mailing address

3704 MURPHY RD
NASHVILLE TN
37209-4906
US

V. Phone/Fax

Practice location:
  • Phone: 503-998-8354
  • Fax:
Mailing address:
  • Phone: 503-998-8354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License NumberA-3189559
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: