Provider Demographics
NPI:1164683587
Name:HANIFY, LAURA LYNN (LMP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:LYNN
Last Name:HANIFY
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 E FRONT ST
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-3113
Mailing Address - Country:US
Mailing Address - Phone:360-565-1199
Mailing Address - Fax:360-565-1166
Practice Address - Street 1:401 E FRONT ST
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-3113
Practice Address - Country:US
Practice Address - Phone:360-565-1199
Practice Address - Fax:360-565-1166
Is Sole Proprietor?:No
Enumeration Date:2008-06-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00009001174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist