Basic Information
| Provider Information | |||||||||
| NPI: | 1154349249 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STAAB | ||||||||
| FirstName: | BARBARA | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MS, ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 27723 21ST PL S | ||||||||
| Address2: | |||||||||
| City: | FEDERAL WAY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980036953 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2535293623 | ||||||||
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| Practice Location | |||||||||
| Address1: | 30809 1ST AVE S STE G | ||||||||
| Address2: | |||||||||
| City: | FEDERAL WAY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980034074 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2539458130 | ||||||||
| FaxNumber: | 2538391071 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | AP30003349 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 0199177 | 01 | WA | LABOR AND INDUSTRIES | OTHER | 9612128 | 05 | WA | MEDICAID |