Provider Demographics
NPI:1215416326
Name:LAPHAM, JONATHAN (ARNP)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:LAPHAM
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4323 57TH STREET CT E
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98443-2441
Mailing Address - Country:US
Mailing Address - Phone:253-241-5774
Mailing Address - Fax:
Practice Address - Street 1:2215 N 30TH ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98403-3350
Practice Address - Country:US
Practice Address - Phone:253-301-4534
Practice Address - Fax:253-302-3997
Is Sole Proprietor?:No
Enumeration Date:2018-08-09
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60892908363LP2300X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2116888Medicaid