Provider Demographics
NPI:1790460178
Name:LAZARE ASSIE, KOUASSI KAN BOUA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:KOUASSI
Middle Name:KAN BOUA
Last Name:LAZARE ASSIE
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1202 BERILLA DR
Mailing Address - Street 2:
Mailing Address - City:ENUMCLAW
Mailing Address - State:WA
Mailing Address - Zip Code:98022-8426
Mailing Address - Country:US
Mailing Address - Phone:206-384-2222
Mailing Address - Fax:425-968-1999
Practice Address - Street 1:13806 123RD AVE NE
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-2248
Practice Address - Country:US
Practice Address - Phone:206-384-2222
Practice Address - Fax:425-968-1999
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-21
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAAP61440338363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health