Healthcare Provider Details
I. General information
NPI: 1144225780
Provider Name (Legal Business Name): LAURA LYNN HERSHKOWITZ D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 06/20/2005
Last Update Date: 09/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
316 MARTIN LUTHER KING JR WAY #408
TACOMA WA
98405-4252
US
IV. Provider business mailing address
316 MARTIN LUTHER KING JR WAY #408
TACOMA WA
98405-4252
US
V. Phone/Fax
- Phone: 253-403-0344
- Fax:
- Phone: 253-403-0344
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2084N0402X |
| Taxonomy | Neurology with Special Qualifications in Child Neurology Physician |
| License Number | OS010193L |
| License Number State | PA |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2084N0402X |
| Taxonomy | Neurology with Special Qualifications in Child Neurology Physician |
| License Number | OP60100685 |
| License Number State | WA |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2084N0400X |
| Taxonomy | Neurology Physician |
| License Number | OP60100685 |
| License Number State | WA |
| # 4 | |
| Primary Taxonomy | N |
| Taxonomy Code | 207T00000X |
| Taxonomy | Neurological Surgery Physician |
| License Number | OP60100685 |
| License Number State | WA |
| # 5 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2084N0008X |
| Taxonomy | Neuromuscular Medicine (Psychiatry & Neurology) Physician |
| License Number | OP60100685 |
| License Number State | WA |
| # 6 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2084A0401X |
| Taxonomy | Addiction Medicine (Psychiatry & Neurology) Physician |
| License Number | OP60100685 |
| License Number State | WA |
| # 7 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2084P0805X |
| Taxonomy | Geriatric Psychiatry Physician |
| License Number | OP60100685 |
| License Number State | WA |
| # 8 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 2084N0600X |
| Taxonomy | Clinical Neurophysiology Physician |
| License Number | OP60100685 |
| License Number State | WA |
| # 9 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2084P0005X |
| Taxonomy | Neurodevelopmental Disabilities Physician |
| License Number | OP60100685 |
| License Number State | WA |
| # 10 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2084P0800X |
| Taxonomy | Psychiatry Physician |
| License Number | OP60100685 |
| License Number State | WA |
| # 11 | |
| Primary Taxonomy | N |
| Taxonomy Code | 204D00000X |
| Taxonomy | Neuromusculoskeletal Medicine & OMM Physician |
| License Number | OP60100685 |
| License Number State | WA |
| # 12 | |
| Primary Taxonomy | N |
| Taxonomy Code | 204C00000X |
| Taxonomy | Sports Medicine (Neuromusculoskeletal Medicine) Physician |
| License Number | OPO60100685 |
| License Number State | WA |
| # 13 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2081N0008X |
| Taxonomy | Neuromuscular Medicine (Physical Medicine & Rehabilitation) Physician |
| License Number | OP60100685 |
| License Number State | WA |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone:
