Provider Demographics
NPI:1437674033
Name:HERSHFIELD, MARIE LOUISE (RN)
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:LOUISE
Last Name:HERSHFIELD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:MARIE
Other - Middle Name:LOUISE
Other - Last Name:GUNDRUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4812 21ST AVE SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-7029
Mailing Address - Country:US
Mailing Address - Phone:715-697-0884
Mailing Address - Fax:
Practice Address - Street 1:4812 21ST AVE SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-7029
Practice Address - Country:US
Practice Address - Phone:715-697-0884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60803173163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100069994Medicaid