Healthcare Provider Details

I. General information

NPI: 1851442313
Provider Name (Legal Business Name): DENISE MARIE HERMANS-SMITH L.M.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19110 BOTHELL WAY NE SUITE 103
BOTHELL WA
98011-2970
US

IV. Provider business mailing address

19711 108TH AVE NE
BOTHELL WA
98011-2413
US

V. Phone/Fax

Practice location:
  • Phone: 206-355-9319
  • Fax: 425-424-0818
Mailing address:
  • Phone: 206-355-9319
  • Fax: 425-424-0818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA00015961
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0178794
Identifier TypeOTHER
Identifier StateWA
Identifier IssuerDEPT. OF L&I PROVIDER

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: