MEDICARE: LAURA VANDERWERF

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	124Q00000X	Dental Hygienist	H6786	OR

General Provider Information

NPI Number	:	1043716731
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA VANDERWERF

Provider Business Mailing Address
First Line	:	1748 NW 8TH AVE
Second Line	:
City	:	HILLSBORO
State	:	OR
Zip	:	97124-2979
Country	:	US
Telephone Number	:	907-957-0165
Fax Number	:

Provider Business Practice Location Address
First Line	:	2501 NE CENTURY BLVD
Second Line	:
City	:	HILLSBORO
State	:	OR
Zip	:	97124-5506
Country	:	US
Telephone Number	:	503-444-0096
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/02/2018
Last Update Date	:	04/02/2018

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Directions to “ LAURA VANDERWERF ” Practice Location

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