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General NPI Number Information
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NPI Number | 1649637497
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Entity Type | Individual
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Provider Name | LAURA JEAN CORNISH ARNP, NP-C
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Gender | Female
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Dates
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Enumeration Date | 01/25/2016
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Last Update Date | 04/17/2025
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Provider Practice Location Address
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Address Line | 1414 S 324TH ST STE B207
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City | FEDERAL WAY
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State | WA
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Zip | 98003-8444
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Country | US
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Telephone | 253-220-3121
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Fax | 415-252-7176
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Provider Business Mailing Address
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Address Line | 1118 28TH AVENUE CT SW
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City | PUYALLUP
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State | WA
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Zip | 98373-1655
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Country | US
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Telephone | 253-370-9671
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN00149975
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | APN0999305NP
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | AP61111004
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License Number State | WA
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