Provider Demographics
NPI:1659340677
Name:SCIBA, LAURA L (PA-C)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:L
Last Name:SCIBA
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 1:33501 1ST WAY S
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6208
Mailing Address - Country:US
Mailing Address - Phone:253-838-2400
Mailing Address - Fax:
Practice Address - Street 1:33501 1ST WAY S
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6208
Practice Address - Country:US
Practice Address - Phone:253-838-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004009363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010149522OtherREGENCE BLUE SHIELD OF ID
WA140374OtherDEPT OF LABOR & INDUSTRIE
WA970027250OtherRR MEDICARE
IDK6427OtherBLUE CROSS OF IDAHO
WA379109600OtherOWCP
ID806062000Medicaid
WA20939OtherGROUP HEALTH NW
WA2891SCOtherASURIS NW HEALTH
WA8387342Medicaid
WA8937371OtherCRIME VICTIMS
IDK6427OtherBLUE CROSS OF IDAHO
P15141Medicare UPIN
WA8387342Medicaid