Healthcare Provider Details

I. General information

NPI: 1457972762
Provider Name (Legal Business Name): SIERRA LAHAIE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2020
Last Update Date: 06/19/2024
Certification Date: 06/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3920 CAPITAL MALL DR SW STE 400
OLYMPIA WA
98502-8703
US

IV. Provider business mailing address

1814 WOODSIDE ST
TRENTON MI
48183-1723
US

V. Phone/Fax

Practice location:
  • Phone: 360-705-1259
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberDO.OP.61547743
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: