Provider Demographics
NPI:1821578295
Name:YUCKERT, LAUREN (LPN)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:YUCKERT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 39680
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98496-3680
Mailing Address - Country:US
Mailing Address - Phone:253-200-0415
Mailing Address - Fax:253-845-4742
Practice Address - Street 1:3800 3RD ST SE
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98374-1109
Practice Address - Country:US
Practice Address - Phone:253-200-0415
Practice Address - Fax:253-845-4742
Is Sole Proprietor?:No
Enumeration Date:2018-08-15
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP00058964164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2001900Medicaid
WAG8888029OtherMEDICARE NSC