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General NPI Number Information
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NPI Number | 1851005813
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Entity Type | Individual
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Provider Name | LAURA L BUCHWALD
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Gender | Female
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Dates
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Enumeration Date | 01/12/2023
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Last Update Date | 01/12/2023
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Provider Practice Location Address
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Address Line | 121 PELLY AVE N
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City | RENTON
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State | WA
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Zip | 98057-5714
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Country | US
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Telephone | 206-743-1933
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Fax |
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Provider Business Mailing Address
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Address Line | 1307 12TH ST NE
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City | AUBURN
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State | WA
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Zip | 98002-3535
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Country | US
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Telephone | 206-503-6606
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 9320
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License Number State | CA
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