Healthcare Provider Details

I. General information

NPI: 1841853298
Provider Name (Legal Business Name): LAUREN ELISE TABAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2019
Last Update Date: 04/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 E MADISON ST
SEATTLE WA
98122-2959
US

IV. Provider business mailing address

PO BOX 24547
SEATTLE WA
98124-0547
US

V. Phone/Fax

Practice location:
  • Phone: 775-742-4585
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAP60938218
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAP60938218
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: