Provider Demographics
NPI:1598804353
Name:MCCOY, LAURA E (LAC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:E
Last Name:MCCOY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:18870 8TH AVE NE
Mailing Address - Street 2:SUITE 8
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-6233
Mailing Address - Country:US
Mailing Address - Phone:360-394-4357
Mailing Address - Fax:360-394-7972
Practice Address - Street 1:18870 8TH AVE NE
Practice Address - Street 2:SUITE 8
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-6233
Practice Address - Country:US
Practice Address - Phone:360-394-4357
Practice Address - Fax:360-394-7972
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAAC00002589171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAC00002589OtherLICENSE