Provider Demographics
NPI:1235356585
Name:ROGERS, LAURIE M (PAC)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:M
Last Name:ROGERS
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2835 36TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-2527
Mailing Address - Country:US
Mailing Address - Phone:360-943-9125
Mailing Address - Fax:
Practice Address - Street 1:PACIFIC LUTHERAN UNIVERSITY STUDENT HEATLH CTR
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98447-0001
Practice Address - Country:US
Practice Address - Phone:253-535-7337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA 10000785363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant