Provider Demographics
NPI:1306274469
Name:PETERSON, LAURA ANN (RN)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ANN
Last Name:PETERSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:ANN
Other - Last Name:KOUSBAUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:4730 COLBY AVE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98203-2927
Mailing Address - Country:US
Mailing Address - Phone:425-385-5250
Mailing Address - Fax:
Practice Address - Street 1:5909 146TH PL SE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-8910
Practice Address - Country:US
Practice Address - Phone:425-385-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-28
Last Update Date:2013-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN 00111063163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA91-6001542OtherEVERETT PUBLIC SCHOOLS EIN#