Provider Demographics
NPI:1427198753
Name:WARNER, MARIE LOUISE (LAC)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:LOUISE
Last Name:WARNER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21212 VIRGINIA AVE NE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:WA
Mailing Address - Zip Code:98346-9137
Mailing Address - Country:US
Mailing Address - Phone:360-813-2516
Mailing Address - Fax:360-616-0884
Practice Address - Street 1:2817 WHEATON WAY
Practice Address - Street 2:STE. 104-C
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-3440
Practice Address - Country:US
Practice Address - Phone:360-813-2516
Practice Address - Fax:360-616-0884
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00002347171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA25465OtherWHOLE HEALTH PRO PIN