Provider Demographics
NPI:1760877765
Name:RADOCCHIA, LAURA GOERGEN (NP)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:GOERGEN
Last Name:RADOCCHIA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:GRACE
Other - Last Name:GOERGEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:8536 TURNERS BAY PL
Mailing Address - Street 2:
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221-9350
Mailing Address - Country:US
Mailing Address - Phone:360-968-6860
Mailing Address - Fax:360-968-6608
Practice Address - Street 1:8536 TURNERS BAY PL
Practice Address - Street 2:
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221-9350
Practice Address - Country:US
Practice Address - Phone:360-968-6860
Practice Address - Fax:360-968-6608
Is Sole Proprietor?:No
Enumeration Date:2015-04-06
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60961186363LP0808X
CA95047545163W00000X
OR201905022NP-PP363LP0808X
CA95004793363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse