=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821525643
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LAURA M CAIN
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/11/2017
-----------------------------------------------------
Last Update Date | 05/11/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3815 184TH ST E
-----------------------------------------------------
City | TACOMA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98446-2757
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-334-2179
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3815 184TH ST E
-----------------------------------------------------
City | TACOMA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98446-2757
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-334-2179
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | STUDENT
-----------------------------------------------------
Name | MS. LAURA M CAIN
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 253-334-2179
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------