Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | OPO60100685 | WA |
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | OP60100685 | WA |
N | 207T00000X | Neurosurgeon | OP60100685 | WA |
N | 2084N0400X | Neurologist | OP60100685 | WA |
N | 2084N0402X | Child Neurologist | OP60100685 | WA |
N | 2084N0402X | Child Neurologist | OS010193L | PA |
Y | 2084N0600X | Clinical Neurophysiologist | OP60100685 | WA |
NPI | 1144225780 |
---|---|
Provider Name | Laura Lynn Hershkowitz |
First Address | Tacoma, WA 98405-4252 |
Second Address | Tacoma, WA 98405-4252 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2005 |
Last Update Date | 22/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0017328760003 | (05) | PA |
130022760 | RAILROAD MEDICARE IND# (01) | PA |
G64638 | (02) | PA |