Healthcare Provider Details

I. General information

NPI: 1154574556
Provider Name (Legal Business Name): ELENA LAER L.AC./EAMP, LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2008
Last Update Date: 03/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 3RD ST SE
PUYALLUP WA
98372-4505
US

IV. Provider business mailing address

1720 3RD ST SE
PUYALLUP WA
98372-4505
US

V. Phone/Fax

Practice location:
  • Phone: 253-904-8954
  • Fax: 253-445-4480
Mailing address:
  • Phone: 253-904-8954
  • Fax: 253-445-4480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC60719689
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00021330
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: