Provider Demographics
NPI:1376638130
Name:COVINGTON, CORTNEE DIANA (LMT)
Entity Type:Individual
Prefix:MRS
First Name:CORTNEE
Middle Name:DIANA
Last Name:COVINGTON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:629 BIRCH AVE
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-3673
Mailing Address - Country:US
Mailing Address - Phone:509-438-6175
Mailing Address - Fax:
Practice Address - Street 1:245 SYMONS ST
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99354-3400
Practice Address - Country:US
Practice Address - Phone:509-438-6175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00014227174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist