Bruce Randall Lanum, RN, MN, CS, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

AP60060142 Issued in WA

Practice address

4401 Bridgeport Way W
Attn Credentialing
University Place, WA 98466-4201

Phone

(253) 564-4157

Fax

(253) 564-4813

NPI assigned

Oct 11, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Practitioner, Registered Nurse

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1454544000000",
    "number": "1205925120",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4401 BRIDGEPORT WAY W",
            "address_2": "ATTN CREDENTIALING",
            "city": "UNIVERSITY PLACE",
            "state": "WA",
            "postal_code": "984664201",
            "telephone_number": "253-564-4157",
            "fax_number": "253-564-4813"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4401 BRIDGEPORT WAY W",
            "address_2": "ATTN CREDENTIALING",
            "city": "UNIVERSITY PLACE",
            "state": "WA",
            "postal_code": "984664201",
            "telephone_number": "253-564-4157",
            "fax_number": "253-564-4813"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LANUM",
        "first_name": "BRUCE",
        "middle_name": "RANDALL",
        "credential": "RN, MN, CS, FNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-11",
        "last_updated": "2016-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WA",
            "license": "AP60060142",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tabby Divine La Brea
• Adriana Laigo
• Tabitha Lamphere, CPC
• Jordan Landholm, DC, DCCJP
• Douglas W Lane, PH. D
• Lapis Family Medicine LLP
• Dacia Helen Larkin, DDS
• Victoria Kay Laroche
• Blake Latour
• Aimee Colleen Lawson, RN

• Family Nurse Practitioner in University Place, WA
• Providers in University Place, WA by specialty
• Family Nurse Practitioner in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.