Provider Demographics
NPI:1427040138
Name:LASKE, JOEY L (ARNP)
Entity Type:Individual
Prefix:DR
First Name:JOEY
Middle Name:L
Last Name:LASKE
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:MR
Other - First Name:JOEY
Other - Middle Name:L
Other - Last Name:LASKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP-C
Mailing Address - Street 1:8511 S TACOMA WAY # 200
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-6521
Mailing Address - Country:US
Mailing Address - Phone:253-588-4015
Mailing Address - Fax:253-588-4035
Practice Address - Street 1:8511 S TACOMA WAY # 200
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499
Practice Address - Country:US
Practice Address - Phone:253-588-4015
Practice Address - Fax:253-588-4035
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-18
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8835111N00000X
WAAP60532668363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX190499701Medicaid
TX606681OtherBLUE CROSS AND BLUE SHIELD
TX606681OtherBLUE CROSS AND BLUE SHIELD
TX190499701Medicaid