1407924566 NPI number — LAURA KATHERINE RAYKOWSKI ARNP

Table of content: LAURA KATHERINE RAYKOWSKI ARNP (NPI 1407924566)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407924566 NPI number — LAURA KATHERINE RAYKOWSKI ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAYKOWSKI
Provider First Name:
LAURA
Provider Middle Name:
KATHERINE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HOLMES
Provider Other First Name:
LAURA
Provider Other Middle Name:
KATHERINE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1407924566
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/29/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
103 E BROADWAY AVE
Provider Second Line Business Mailing Address:
HOMETOWN FAMILY HEALTH
Provider Business Mailing Address City Name:
MONTESANO
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98563-3703
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-249-8528
Provider Business Mailing Address Fax Number:
360-249-8541

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
103 E BROADWAY AVE
Provider Second Line Business Practice Location Address:
HOMETOWN FAMILY HEALTH
Provider Business Practice Location Address City Name:
MONTESANO
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98563-3703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-249-8528
Provider Business Practice Location Address Fax Number:
360-249-8541
Provider Enumeration Date:
11/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP2300X , with the licence number:  AP30006830 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com