Provider Demographics
NPI:1457395311
Name:ZUBERI, LAUREL R (NP)
Entity Type:Individual
Prefix:
First Name:LAUREL
Middle Name:R
Last Name:ZUBERI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9135 SW BARNES RD STE 985
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-6699
Mailing Address - Country:US
Mailing Address - Phone:503-297-3336
Mailing Address - Fax:503-297-3338
Practice Address - Street 1:9135 SW BARNES RD STE 985
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6699
Practice Address - Country:US
Practice Address - Phone:503-297-3336
Practice Address - Fax:503-297-3338
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200850030NP FNP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200369070AMedicaid
MO420501108Medicaid
MO420501108Medicaid