Provider Demographics
NPI:1386077998
Name:ADIELE, LAURA NGOZI (FNP-BC)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:NGOZI
Last Name:ADIELE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4725 196TH ST SW STE 105
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-5518
Mailing Address - Country:US
Mailing Address - Phone:425-640-5115
Mailing Address - Fax:
Practice Address - Street 1:4725 196TH ST SW STE 105
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-5518
Practice Address - Country:US
Practice Address - Phone:425-640-5115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-19
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60903439363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily