Provider Demographics
NPI:1649239823
Name:LASSITER, NICOLE THERESA (ARNP CNM)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:THERESA
Last Name:LASSITER
Suffix:
Gender:F
Credentials:ARNP CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6002 NO WESTGATE BLVD
Mailing Address - Street 2:STE 230
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406
Mailing Address - Country:US
Mailing Address - Phone:253-761-2244
Mailing Address - Fax:253-761-1040
Practice Address - Street 1:6002 NO WESTGATE BLVD
Practice Address - Street 2:STE 230
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406
Practice Address - Country:US
Practice Address - Phone:253-761-2244
Practice Address - Fax:253-761-1040
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00162588163W00000X
WAAP30007210363L00000X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Not Answered367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife