Basic Information
| Provider Information | |||||||||
| NPI: | 1659340677 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCIBA | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 33501 1ST WAY S | ||||||||
| Address2: | |||||||||
| City: | FEDERAL WAY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980036208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2538382400 | ||||||||
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| Practice Location | |||||||||
| Address1: | 33501 1ST WAY S | ||||||||
| Address2: | |||||||||
| City: | FEDERAL WAY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980036208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2538382400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2006 | ||||||||
| LastUpdateDate: | 01/11/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA10004009 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 000010149522 | 01 | ID | REGENCE BLUE SHIELD OF ID | OTHER | 140374 | 01 | WA | DEPT OF LABOR & INDUSTRIE | OTHER | 970027250 | 01 | WA | RR MEDICARE | OTHER | K6427 | 01 | ID | BLUE CROSS OF IDAHO | OTHER | 379109600 | 01 | WA | OWCP | OTHER | 806062000 | 05 | ID | MEDICAID | 20939 | 01 | WA | GROUP HEALTH NW | OTHER | 2891SC | 01 | WA | ASURIS NW HEALTH | OTHER | 8387342 | 05 | WA | MEDICAID | 8937371 | 01 | WA | CRIME VICTIMS | OTHER |