Provider Demographics
NPI: | 1598001299 |
---|---|
Name: | MUST, LAUREN ANN (PA-C) |
Entity Type: | Individual |
Prefix: | |
First Name: | LAUREN |
Middle Name: | ANN |
Last Name: | MUST |
Suffix: | |
Gender: | F |
Credentials: | PA-C |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 1229 MADISON ST STE 1600 |
Mailing Address - Street 2: | |
Mailing Address - City: | SEATTLE |
Mailing Address - State: | WA |
Mailing Address - Zip Code: | 98104-3590 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 206-860-4692 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1229 MADISON ST STE 1600 |
Practice Address - Street 2: | |
Practice Address - City: | SEATTLE |
Practice Address - State: | WA |
Practice Address - Zip Code: | 98104-3590 |
Practice Address - Country: | US |
Practice Address - Phone: | 206-860-4692 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2012-12-27 |
Last Update Date: | 2018-03-17 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
AK | PADA1086 | 363AM0700X |
WA | PA60794983 | 363AS0400X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363AS0400X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
No | 363AM0700X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
AK | 1581862 | Medicaid | |
AK | K167350 | Medicare PIN |