Provider Demographics
NPI:1023309135
Name:PEREZ, LAURA ANN (ARNP, PMHNP)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:ANN
Last Name:PEREZ
Suffix:
Gender:F
Credentials:ARNP, PMHNP
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 15192
Mailing Address - Street 2:
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98082-3192
Mailing Address - Country:US
Mailing Address - Phone:206-940-2301
Mailing Address - Fax:425-379-9587
Practice Address - Street 1:1728 W MARINE VIEW DR STE 109
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-2094
Practice Address - Country:US
Practice Address - Phone:206-940-2301
Practice Address - Fax:425-379-9587
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-22
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60214612363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2163107Medicaid
WAG8901973Medicare PIN