Provider Demographics
NPI:1083892764
Name:SYLVIA G LAGDAN MN ARNP BC PLLC
Entity Type:Organization
Organization Name:SYLVIA G LAGDAN MN ARNP BC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SYLVIA
Authorized Official - Middle Name:G
Authorized Official - Last Name:LAGDAN
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:253-549-4404
Mailing Address - Street 1:PO BOX 1718
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98071-1718
Mailing Address - Country:US
Mailing Address - Phone:253-833-3255
Mailing Address - Fax:253-549-4494
Practice Address - Street 1:7414 91ST AVENUE CT SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98498-3978
Practice Address - Country:US
Practice Address - Phone:253-833-3255
Practice Address - Fax:253-549-4494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-05
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006715364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9643115Medicaid
WAQ21529Medicare UPIN
WA9643115Medicaid