MEDICARE: LAURIE HEUERMANN MD

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	207L00000X	Anesthesiology Physician	MD00023518	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881698405
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURIE HEUERMANN MD

Provider Business Mailing Address
First Line	:	PO BOX 97115
Second Line	:
City	:	LAKEWOOD
State	:	WA
Zip	:	98497-0115
Country	:	US
Telephone Number	:	253-588-7911
Fax Number	:

Provider Business Practice Location Address
First Line	:	1625 MOTTMAN RD SW
Second Line	:	STE B
City	:	TUMWATER
State	:	WA
Zip	:	98512-7833
Country	:	US
Telephone Number	:	360-754-5858
Fax Number	:

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

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	03/18/2008

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