Healthcare Provider Details

I. General information

NPI: 1972949642
Provider Name (Legal Business Name): LAURA P.S. TWIST M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA PROEHL SHOEMAKER MD

II. Dates (important events)

Enumeration Date: 05/21/2013
Last Update Date: 11/13/2023
Certification Date: 11/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

672 STONELEIGH AVE STE C112
CARMEL NY
10512-4635
US

IV. Provider business mailing address

400 S CLARK ST
BUTTE MT
59701-2328
US

V. Phone/Fax

Practice location:
  • Phone: 203-739-7131
  • Fax: 203-739-1554
Mailing address:
  • Phone: 406-723-2933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMED-PHYS-LIC-58089
License Number StateMT
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number322364
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: