Provider Demographics
NPI:1225273907
Name:BIEHL, LARA MICHELLE (LMP)
Entity Type:Individual
Prefix:MRS
First Name:LARA
Middle Name:MICHELLE
Last Name:BIEHL
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1975
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:WA
Mailing Address - Zip Code:98584-5030
Mailing Address - Country:US
Mailing Address - Phone:360-426-6325
Mailing Address - Fax:360-426-8300
Practice Address - Street 1:422 N 1ST ST
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:WA
Practice Address - Zip Code:98584-3410
Practice Address - Country:US
Practice Address - Phone:360-426-6325
Practice Address - Fax:360-426-8300
Is Sole Proprietor?:No
Enumeration Date:2008-12-09
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00022030174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0205636OtherDEPARTMENT OF LABOR AND INDUSTRIES