Provider Demographics
NPI:1285077529
Name:POPKO, LAURA N
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:N
Last Name:POPKO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11800 NE 128TH ST STE 300
Mailing Address - Street 2:EVERGREENHEALTH PLAZA BUILDING
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-7211
Mailing Address - Country:US
Mailing Address - Phone:425-814-5100
Mailing Address - Fax:425-814-5103
Practice Address - Street 1:11800 NE 128TH ST STE 300
Practice Address - Street 2:EVERGREENHEALTH PLAZA BUILDING
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-7211
Practice Address - Country:US
Practice Address - Phone:425-814-5100
Practice Address - Fax:425-814-5103
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-16
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60659937207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine