Healthcare Provider Details

I. General information

NPI: 1912999327
Provider Name (Legal Business Name): LISANNE G LAURIER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 07/21/2022
Certification Date:
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 Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberMD00042914
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: