Individual
LAURA LYNN WILLOUGHBY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
700 NE 87TH AVE STE 250, VANCOUVER, WA 98664-4896
(360) 882-2778
(360) 604-1727
Mailing address
PO BOX 4825, PORTLAND, OR 97208-4825
(360) 882-2778
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
148408
CA
207R00000X
Internal Medicine Physician
MD61022155
WA
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
MD61022155
WA
207RP1001X
Pulmonary Disease Physician
A148408
CA
207RP1001X
Pulmonary Disease Physician
Primary
MD61022155
WA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2159739
—
WA
Enumeration date
04/05/2014
Last updated
10/14/2020
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