Basic Information
| Provider Information | |||||||||
| NPI: | 1215416326 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LAPHAM | ||||||||
| FirstName: | JONATHAN | ||||||||
| MiddleName: | |||||||||
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| Credential: | RN (ARNP STUDENT) | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9230 SKY ISLAND DR E | ||||||||
| Address2: | |||||||||
| City: | BONNEY LAKE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983917385 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2537506000 | ||||||||
| FaxNumber: | 2536276576 | ||||||||
| Practice Location | |||||||||
| Address1: | 9230 SKY ISLAND DR E | ||||||||
| Address2: | |||||||||
| City: | BONNEY LAKE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983917385 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2537506000 | ||||||||
| FaxNumber: | 2536276576 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2018 | ||||||||
| LastUpdateDate: | 12/07/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | AP60892908 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 363LP2300X | AP60892908 | WA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care |
ID Information
| ID | Type | State | Issuer | Description | 2116888 | 05 | WA | MEDICAID |