Provider Demographics
NPI:1407538457
Name:HALL, LAURA CHARLENE (DNP, FNP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:CHARLENE
Last Name:HALL
Suffix:
Gender:F
Credentials:DNP, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:447 MORRIS AVE S
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-2556
Mailing Address - Country:US
Mailing Address - Phone:509-675-7820
Mailing Address - Fax:
Practice Address - Street 1:1404 CENTRAL AVE S STE 110
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-7433
Practice Address - Country:US
Practice Address - Phone:206-320-5325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN61087758163W00000X
WAAP61471039363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner