Provider Demographics
NPI:1649637497
Name:CORNISH, LAURA JEAN (ARNP, NP-C)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:JEAN
Last Name:CORNISH
Suffix:
Gender:
Credentials:ARNP, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1118 28TH AVENUE CT SW
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-1655
Mailing Address - Country:US
Mailing Address - Phone:253-370-9671
Mailing Address - Fax:
Practice Address - Street 1:1414 S 324TH ST STE B207
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-8444
Practice Address - Country:US
Practice Address - Phone:253-220-3121
Practice Address - Fax:415-252-7176
Is Sole Proprietor?:No
Enumeration Date:2016-01-25
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00149975163W00000X
COAPN0999305NP363LA2200X
WAAP61111004363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse