Provider Demographics
NPI:1972496677
Name:LAURENT, ANDRIANNA (LMT)
Entity type:Individual
Prefix:
First Name:ANDRIANNA
Middle Name:
Last Name:LAURENT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:NINA
Other - Middle Name:
Other - Last Name:LAURENT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT
Mailing Address - Street 1:3828 SE 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-3815
Mailing Address - Country:US
Mailing Address - Phone:312-550-4103
Mailing Address - Fax:
Practice Address - Street 1:1111 SE STEPHENS ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-4748
Practice Address - Country:US
Practice Address - Phone:971-544-7058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-31
Last Update Date:2025-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR28868225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist