Healthcare Provider Details

I. General information

NPI: 1619918893
Provider Name (Legal Business Name): LAURA O REKA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 12/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

945 GOETHALS DR SUITE 200
RICHLAND WA
99352-3552
US

IV. Provider business mailing address

945 GOETHALS DR SUITE 200
RICHLAND WA
99352-3552
US

V. Phone/Fax

Practice location:
  • Phone: 509-942-6327
  • Fax: 509-946-0707
Mailing address:
  • Phone: 509-942-3627
  • Fax: 509-946-0707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberPA10003903
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberAP10003903
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: