Provider Demographics
NPI:1396937645
Name:HANSEN, LAURA STJERN (LMP LAMP)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:STJERN
Last Name:HANSEN
Suffix:
Gender:F
Credentials:LMP LAMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:712 SWIFT BLVD
Mailing Address - Street 2:SUITE 3B
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-3578
Mailing Address - Country:US
Mailing Address - Phone:509-302-7747
Mailing Address - Fax:509-946-4422
Practice Address - Street 1:712 SWIFT BLVD
Practice Address - Street 2:SUITE 3B
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3578
Practice Address - Country:US
Practice Address - Phone:509-302-7747
Practice Address - Fax:509-946-4422
Is Sole Proprietor?:No
Enumeration Date:2007-08-10
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA#0003337225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist