Healthcare Provider Details

I. General information

NPI: 1073990651
Provider Name (Legal Business Name): LAURA J. SKANSE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2015
Last Update Date: 03/02/2021
Certification Date: 03/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 PACIFIC AVE STE 300
EVERETT WA
98201-4261
US

IV. Provider business mailing address

1100 PACIFIC AVE STE 300
EVERETT WA
98201-4261
US

V. Phone/Fax

Practice location:
  • Phone: 425-339-2433
  • Fax: 425-339-8273
Mailing address:
  • Phone: 425-339-2433
  • Fax: 425-339-8273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number60616440
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: