Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | AP60214612 | WA |
NPI | 1023309135 |
---|---|
Provider Name | Mrs. Laura Ann Perez |
First Address | Mill Creek, WA 98082-3192 |
Second Address | Everett, WA 98201-2094 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2011 |
Last Update Date | 20/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2163107 | (05) | WA |