Healthcare Provider Details

I. General information

NPI: 1700218682
Provider Name (Legal Business Name): LARA ANN DANSKIN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LARA ANN HEISE PA-C

II. Dates (important events)

Enumeration Date: 08/02/2013
Last Update Date: 06/27/2022
Certification Date: 06/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3015 SQUALICUM PKWY STE 200 CENTER FOR ORTHOPEDICS AND SPORTS MEDICINE
BELLINGHAM WA
98225-1906
US

IV. Provider business mailing address

1115 SE 164TH AVE DEPT 358
VANCOUVER WA
98683-9324
US

V. Phone/Fax

Practice location:
  • Phone: 360-733-2092
  • Fax: 360-788-6042
Mailing address:
  • Phone: 360-729-1462
  • Fax: 360-729-3104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number60398940
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number60398940
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number60398940
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: