Individual
LAUREL HICKOK HARTWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1501 NE MEDICAL CENTER DR, BEND, OR 97701-6051
(541) 382-2811
Mailing address
PO BOX 6048, BEND, OR 97708-6048
(541) 382-2811
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
MD151664
OR
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12725068
CAQH
OR
05
—
500624979
—
OR
01
—
P01357484
RAILROAD MEDICARE
OR
Enumeration date
04/27/2007
Last updated
03/29/2021
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