Provider Demographics
NPI:1801252853
Name:SHIMEK, LARA HETZLER (ND)
Entity type:Individual
Prefix:DR
First Name:LARA
Middle Name:HETZLER
Last Name:SHIMEK
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:638 SPARTANBURG HWY #70 PMB188
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28792-5921
Mailing Address - Country:US
Mailing Address - Phone:828-424-8310
Mailing Address - Fax:
Practice Address - Street 1:638 SPARTANBURG HWY STE 70
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28792-5921
Practice Address - Country:US
Practice Address - Phone:828-424-8310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-06
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT60606584175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath