Provider Demographics
NPI:1598949489
Name:LAURAL J SCHABERG MSN ARNP PS
Entity Type:Organization
Organization Name:LAURAL J SCHABERG MSN ARNP PS
Other - Org Name:PACIFIC NORTHWEST PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURAL
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCHABERG
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:253-473-7637
Mailing Address - Street 1:1818 SOUTH UNION AVE
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405
Mailing Address - Country:US
Mailing Address - Phone:253-473-7637
Mailing Address - Fax:253-671-8472
Practice Address - Street 1:1818 SOUTH UNION AVE
Practice Address - Street 2:SUITE 2A
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405
Practice Address - Country:US
Practice Address - Phone:253-473-7637
Practice Address - Fax:253-671-8472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30004746363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9622259Medicaid
WAS72227Medicare UPIN
WA9622259Medicaid