Provider Demographics
NPI:1265761621
Name:WINDHAM, LAURA G (RN MSN)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:G
Last Name:WINDHAM
Suffix:
Gender:F
Credentials:RN MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 22ND AVENUE CT SW
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98371-7328
Mailing Address - Country:US
Mailing Address - Phone:253-318-0136
Mailing Address - Fax:
Practice Address - Street 1:401 22ND AVENUE CT SW
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98371-7328
Practice Address - Country:US
Practice Address - Phone:253-318-0136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-15
Last Update Date:2021-09-23
Deactivation Date:2017-12-27
Deactivation Code:
Reactivation Date:2021-09-23
Provider Licenses
StateLicense IDTaxonomies
WARN00141437163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse