Provider Demographics
NPI:1407924566
Name:RAYKOWSKI, LAURA KATHERINE (ARNP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:KATHERINE
Last Name:RAYKOWSKI
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:KATHERINE
Other - Last Name:HOLMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:103 E BROADWAY AVE
Mailing Address - Street 2:HOMETOWN FAMILY HEALTH
Mailing Address - City:MONTESANO
Mailing Address - State:WA
Mailing Address - Zip Code:98563-3703
Mailing Address - Country:US
Mailing Address - Phone:360-249-8528
Mailing Address - Fax:360-249-8541
Practice Address - Street 1:103 E BROADWAY AVE
Practice Address - Street 2:HOMETOWN FAMILY HEALTH
Practice Address - City:MONTESANO
Practice Address - State:WA
Practice Address - Zip Code:98563-3703
Practice Address - Country:US
Practice Address - Phone:360-249-8528
Practice Address - Fax:360-249-8541
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006830363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q38600Medicare UPIN
WA8851763Medicare ID - Type Unspecified