Healthcare Provider Details

I. General information

NPI: 1205471414
Provider Name (Legal Business Name): LAUREN EMILY KUIPER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2019
Last Update Date: 04/19/2021
Certification Date: 04/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1708 YAKIMA AVE STE 300
TACOMA WA
98405-5309
US

IV. Provider business mailing address

1708 YAKIMA AVE STE 300
TACOMA WA
98405-5309
US

V. Phone/Fax

Practice location:
  • Phone: 253-363-8700
  • Fax: 253-272-0419
Mailing address:
  • Phone: 253-363-8700
  • Fax: 253-272-0419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP61095106
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number26772
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number26772
License Number StateTN
# 4
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAP61095106
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: