Provider Demographics
NPI:1457028631
Name:WALKER-COFFEY, LAURIE MARIE (RDH)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:MARIE
Last Name:WALKER-COFFEY
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 N 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:STAYTON
Mailing Address - State:OR
Mailing Address - Zip Code:97383-1703
Mailing Address - Country:US
Mailing Address - Phone:503-769-9699
Mailing Address - Fax:
Practice Address - Street 1:521 N 1ST AVE
Practice Address - Street 2:
Practice Address - City:STAYTON
Practice Address - State:OR
Practice Address - Zip Code:97383-1703
Practice Address - Country:US
Practice Address - Phone:503-769-9699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-25
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH3559124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist