MEDICARE: LAURA ELIZABETH CREITZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator
2	372600000X	Adult Companion

General Provider Information

NPI Number	:	1134316383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA ELIZABETH CREITZ

Provider Business Mailing Address
First Line	:	6516 SE REEDWAY ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97206-5455
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6516 SE REEDWAY ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97206-5455
Country	:	US
Telephone Number	:	503-238-0769
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2007
Last Update Date	:	10/02/2007

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Directions to “ LAURA ELIZABETH CREITZ ” Practice Location

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