Provider Demographics
NPI:1861420275
Name:LANTSBERGER, PAULA A (MD MPH)
Entity type:Individual
Prefix:DR
First Name:PAULA
Middle Name:A
Last Name:LANTSBERGER
Suffix:
Gender:F
Credentials:MD MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 W BOONE AVE STE 268
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-2346
Mailing Address - Country:US
Mailing Address - Phone:509-993-4714
Mailing Address - Fax:509-537-0485
Practice Address - Street 1:316 W BOONE AVE STE 268
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-2346
Practice Address - Country:US
Practice Address - Phone:509-993-4714
Practice Address - Fax:509-537-0485
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAWA000241482083X0100X
WAMD000241482083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8152258Medicaid
WA416671OtherWASHINGTON STATE LABOR AND INDUSTRIES
WA45148OtherSTATE LABOR & INDUSTRIES
WA8152258Medicaid