Provider Demographics
NPI:1265456644
Name:CENTER FOR LIFESTYLE MEDICINE AND HORMONE HEALTH PS
Entity Type:Organization
Organization Name:CENTER FOR LIFESTYLE MEDICINE AND HORMONE HEALTH PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:
Authorized Official - First Name:LISANNE
Authorized Official - Middle Name:G
Authorized Official - Last Name:LAURIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-456-5433
Mailing Address - Street 1:907 S PERRY ST STE 240
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-3462
Mailing Address - Country:US
Mailing Address - Phone:509-456-5433
Mailing Address - Fax:509-456-3557
Practice Address - Street 1:907 S PERRY ST STE 240
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-3462
Practice Address - Country:US
Practice Address - Phone:509-456-5433
Practice Address - Fax:509-456-3557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2023-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00042914174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAH96590Medicare UPIN