Provider Demographics
NPI:1043297187
Name:HIERSCHE, DANIEL LOUIS (MD)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:LOUIS
Last Name:HIERSCHE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5124 NANEUM RD
Mailing Address - Street 2:
Mailing Address - City:ELLENSBURG
Mailing Address - State:WA
Mailing Address - Zip Code:98926-6959
Mailing Address - Country:US
Mailing Address - Phone:509-925-2663
Mailing Address - Fax:
Practice Address - Street 1:700 E MANITOBA AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926-3885
Practice Address - Country:US
Practice Address - Phone:509-962-6727
Practice Address - Fax:509-962-1994
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-29
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00022370174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1115476Medicaid
WA157669OtherLABOR & INDUSTRIES
WA8856365Medicare ID - Type UnspecifiedQUINCY LOCATION
WA1115476Medicaid
WA157669OtherLABOR & INDUSTRIES