Provider Demographics
NPI:1346582012
Name:LARA, TERAH R (LM, CPM)
Entity Type:Individual
Prefix:
First Name:TERAH
Middle Name:R
Last Name:LARA
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1913 WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:ENUMCLAW
Mailing Address - State:WA
Mailing Address - Zip Code:98022-3303
Mailing Address - Country:US
Mailing Address - Phone:206-227-2211
Mailing Address - Fax:
Practice Address - Street 1:1751 COLE ST
Practice Address - Street 2:
Practice Address - City:ENUMCLAW
Practice Address - State:WA
Practice Address - Zip Code:98022-3507
Practice Address - Country:US
Practice Address - Phone:206-227-2211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-20
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife