Provider Demographics
NPI:1912999327
Name:LAURIER, LISANNE G (MD)
Entity type:Individual
Prefix:
First Name:LISANNE
Middle Name:G
Last Name:LAURIER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:907 S PERRY ST
Mailing Address - Street 2:STE 240
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-3462
Mailing Address - Country:US
Mailing Address - Phone:509-456-5433
Mailing Address - Fax:509-456-3557
Practice Address - Street 1:907 S PERRY ST STE 240
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-3462
Practice Address - Country:US
Practice Address - Phone:509-456-5433
Practice Address - Fax:509-456-3557
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00042914207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8367328Medicaid
H96590Medicare UPIN
WAAB40040Medicare ID - Type Unspecified