Healthcare Provider Details

I. General information

NPI: 1205459328
Provider Name (Legal Business Name): LAURA M. MATSUNAMI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA M. DUNCAN

II. Dates (important events)

Enumeration Date: 05/22/2020
Last Update Date: 12/21/2022
Certification Date: 12/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 SE 8TH AVE STE 536
HILLSBORO OR
97123-4218
US

IV. Provider business mailing address

10431 NE 52ND ST
KIRKLAND WA
98033-7601
US

V. Phone/Fax

Practice location:
  • Phone: 503-352-7272
  • Fax:
Mailing address:
  • Phone: 425-941-4075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA61350390
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: