Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LC1500X | Nurse Practitioner - Community Health | AP30004746 | WA |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | AP30004746 | WA |
NPI | 1104814284 |
---|---|
Provider Name | Laural Janet Schaberg |
First Address | Denver, CO 80216-4923 |
Second Address | Tacoma, WA 98409-6819 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2005 |
Last Update Date | 10/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
9622259 | (05) | WA |
9636101 | (05) | WA |
AP30004746 | APRN LICENSE (01) | WA |
MS0375320 | DEA (01) | WA |
S72227 | (02) | WA |