Healthcare Provider Details

I. General information

NPI: 1265456644
Provider Name (Legal Business Name): CENTER FOR LIFESTYLE MEDICINE AND HORMONE HEALTH PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/08/2023
Certification Date: 07/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

907 S PERRY ST STE 240
SPOKANE WA
99202-3462
US

IV. Provider business mailing address

907 S PERRY ST STE 240
SPOKANE WA
99202-3462
US

V. Phone/Fax

Practice location:
  • Phone: 509-456-5433
  • Fax: 509-456-3557
Mailing address:
  • Phone: 509-456-5433
  • Fax: 509-456-3557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD00042914
License Number StateWA

VIII. Authorized Official

Name: LISANNE G LAURIER
Title or Position: DR.
Credential: MD
Phone: 505-456-5433