Provider Demographics
NPI:1114481140
Name:HANEY, LAURA J (BA, BSN)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:J
Last Name:HANEY
Suffix:
Gender:F
Credentials:BA, BSN
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:I
Other - Last Name:HUNTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:107 S DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-1510
Mailing Address - Country:US
Mailing Address - Phone:509-838-4651
Mailing Address - Fax:
Practice Address - Street 1:1090 W PARK PL
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2785
Practice Address - Country:US
Practice Address - Phone:208-415-0299
Practice Address - Fax:208-625-2070
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-23
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID58301363LP0808X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAHANEYLJ296LRC1451398OtherDRIVERS LICENSE