Healthcare Provider Details

I. General information

NPI: 1609536440
Provider Name (Legal Business Name): CALYPSO NICOLE LAUBHAN CPNP-AC, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CALYPSO NICOLE GRUBB RN

II. Dates (important events)

Enumeration Date: 12/21/2021
Last Update Date: 12/29/2021
Certification Date: 12/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 SAND POINT WAY NE
SEATTLE WA
98105-3901
US

IV. Provider business mailing address

2652 S QUITMAN ST
DENVER CO
80219-5724
US

V. Phone/Fax

Practice location:
  • Phone: 206-987-2170
  • Fax: 206-987-3866
Mailing address:
  • Phone: 303-525-1376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAP61247701
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number61250730
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License NumberAP61247701
License Number StateWA
# 4
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAP61247701
License Number StateWA
# 5
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number61250730
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: