Provider Demographics
NPI:1295151645
Name:ADAMS, LAURIE
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:ADAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10404 NE 19TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98664-4383
Mailing Address - Country:US
Mailing Address - Phone:360-931-3618
Mailing Address - Fax:360-836-5773
Practice Address - Street 1:10404 NE 19TH ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-4383
Practice Address - Country:US
Practice Address - Phone:360-931-3618
Practice Address - Fax:360-836-5773
Is Sole Proprietor?:No
Enumeration Date:2014-03-10
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00130677163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse