Provider Demographics
NPI:1639293665
Name:HERRERA, LAURA J (LMP NCTMB)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:J
Last Name:HERRERA
Suffix:
Gender:F
Credentials:LMP NCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 1ST ST
Mailing Address - Street 2:SUITE 8
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-2247
Mailing Address - Country:US
Mailing Address - Phone:509-667-9300
Mailing Address - Fax:
Practice Address - Street 1:6 1ST ST
Practice Address - Street 2:SUITE 8
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-2247
Practice Address - Country:US
Practice Address - Phone:509-667-9300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00013251225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA121727OtherLABOR AND INDUSTRIES