Healthcare Provider Details

I. General information

NPI: 1407208176
Provider Name (Legal Business Name): PAULINE LAO DNP, ARNP, AGPCNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2016
Last Update Date: 09/30/2022
Certification Date: 09/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 9TH AVE
SEATTLE WA
98101-2756
US

IV. Provider business mailing address

1100 9TH AVE
SEATTLE WA
98101-2756
US

V. Phone/Fax

Practice location:
  • Phone: 206-341-0708
  • Fax: 206-341-0625
Mailing address:
  • Phone: 206-341-0708
  • Fax: 206-341-0625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP60671443
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: