Provider Demographics
NPI:1104814284
Name:SCHABERG, LAURAL JANET (ARNP)
Entity type:Individual
Prefix:
First Name:LAURAL
Middle Name:JANET
Last Name:SCHABERG
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1628 S MILDRED ST STE 105
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98465-1628
Mailing Address - Country:US
Mailing Address - Phone:253-473-7637
Mailing Address - Fax:253-671-8472
Practice Address - Street 1:1628 S MILDRED ST STE 105
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98465-1628
Practice Address - Country:US
Practice Address - Phone:253-473-7637
Practice Address - Fax:253-671-8472
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-12
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30004746207Q00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAP30004746OtherAPRN LICENSE
WA9622259Medicaid
WA9636101Medicaid
WAMS0375320OtherDEA
WA8802914Medicare ID - Type UnspecifiedPROVIDER NUMBER