Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RH0002X | Hospice and Palliative Medicine | MD00044964 | WA |
Y | 2084N0400X | Neurologist | MD00044964 | WA |
NPI | 1134124639 |
---|---|
Provider Name | Lawrence H. Neville |
First Address | Longview, WA 98632-7154 |
Second Address | Longview, WA 98632-2310 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2005 |
Last Update Date | 12/06/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
022559 | (05) | OR |
196953 | LABOR & IND. (01) | WA |
8402265 | (05) | WA |
8905955 | CRIME VICTIMS (01) | WA |
I11186 | (02) | |
P00256993 | RR MEDICARE (01) |