Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 0101055365 | VA |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 0101055365 | VA |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | MD60640657 | WA |
NPI | 1043281439 |
---|---|
Provider Name | Dr. Elizabeth C Hersch |
First Address | Steilacoom, WA 98388-2817 |
Second Address | Tacoma, WA 98493-0003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2006 |
Last Update Date | 17/11/2016 |