Healthcare Provider Details

I. General information

NPI: 1902153885
Provider Name (Legal Business Name): LAURIE LYNNE SHORT RN00129637
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2012
Last Update Date: 08/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4515 MARTIN LUTHER KING JR WAY S STE 100
SEATTLE WA
98108-2183
US

IV. Provider business mailing address

4515 MARTIN LUTHER KING JR WAY S STE 100
SEATTLE WA
98108-2183
US

V. Phone/Fax

Practice location:
  • Phone: 206-760-6403
  • Fax: 206-760-6339
Mailing address:
  • Phone: 206-760-6403
  • Fax: 206-760-6339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License NumberRN00129637
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: