Provider Demographics
NPI:1811901150
Name:LADENBURG, DENISE ANNE (ARNP)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:ANNE
Last Name:LADENBURG
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 S MERIDIAN
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98371-7531
Mailing Address - Country:US
Mailing Address - Phone:253-848-2303
Mailing Address - Fax:253-848-8956
Practice Address - Street 1:1910 S MERIDIAN
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98371-7531
Practice Address - Country:US
Practice Address - Phone:253-848-2303
Practice Address - Fax:253-848-8956
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30005642363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9633470Medicaid