Healthcare Provider Details

I. General information

NPI: 1104814284
Provider Name (Legal Business Name): LAURAL JANET SCHABERG ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2607 BRIDGEPORT WAY W STE 1A
UNIVERSITY PLACE WA
98466-4721
US

IV. Provider business mailing address

2607 BRIDGEPORT WAY W STE 1A
UNIVERSITY PLACE WA
98466-4721
US

V. Phone/Fax

Practice location:
  • Phone: 253-473-7637
  • Fax: 253-671-8472
Mailing address:
  • Phone: 253-473-7637
  • Fax: 253-671-8472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberAP30004746
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP30004746
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: