Healthcare Provider Details

I. General information

NPI: 1629084041
Provider Name (Legal Business Name): LAUREL I POWERS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 03/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1708 E 44TH ST
TACOMA WA
98404-4611
US

IV. Provider business mailing address

1019 PACIFIC AVE SUITE 300
TACOMA WA
98402-4443
US

V. Phone/Fax

Practice location:
  • Phone: 253-471-4553
  • Fax:
Mailing address:
  • Phone: 253-722-1576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG89166
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD00042620
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD00042620
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: