Healthcare Provider Details

I. General information

NPI: 1043297187
Provider Name (Legal Business Name): DANIEL LOUIS HIERSCHE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 12/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 E MANITOBA AVE SUITE 106
ELLENSBURG WA
98926-3885
US

IV. Provider business mailing address

5124 NANEUM RD
ELLENSBURG WA
98926-6959
US

V. Phone/Fax

Practice location:
  • Phone: 509-962-6727
  • Fax: 509-962-1994
Mailing address:
  • Phone: 509-925-2663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD00022370
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: