Basic Information
Provider Information | |||||||||
NPI: | 1740410257 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | PIERCE | ||||||||
FirstName: | LAURA | ||||||||
MiddleName: | Y | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | ARNP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | YOUNG | ||||||||
OtherFirstName: | LAURA | ||||||||
OtherMiddleName: | KAY | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | ARNP | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 2420 S UNION AVE | ||||||||
Address2: | STE 200 | ||||||||
City: | TACOMA | ||||||||
State: | WA | ||||||||
PostalCode: | 984051322 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2532728148 | ||||||||
FaxNumber: | 2534040506 | ||||||||
Practice Location | |||||||||
Address1: | 3209 S 23RD ST | ||||||||
Address2: | SUITE 340 | ||||||||
City: | TACOMA | ||||||||
State: | WA | ||||||||
PostalCode: | 984051602 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2532728148 | ||||||||
FaxNumber: | 2534040506 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/17/2009 | ||||||||
LastUpdateDate: | 04/10/2014 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 1-100522 | AL | N |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |   | 363LF0000X | RN60107157 | WA | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
ID | Type | State | Issuer | Description | 1-100522 | 01 | AL | LICENSE | OTHER | AP60107354 | 01 | WA | WA LICENSE | OTHER | CD8128 | 01 | WA | GROUP RR# | OTHER | RN60107157 | 01 | WA | LICENSE | OTHER |