Provider Demographics
NPI:1538142732
Name:MARCINKOWSKI, P LAURINE (PHD)
Entity Type:Individual
Prefix:DR
First Name:P
Middle Name:LAURINE
Last Name:MARCINKOWSKI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92ND MEDICAL GROUP
Mailing Address - Street 2:200 N. CHENNAULT STE 100
Mailing Address - City:FAIRCHILD AFB
Mailing Address - State:WA
Mailing Address - Zip Code:99011
Mailing Address - Country:US
Mailing Address - Phone:509-247-2731
Mailing Address - Fax:509-247-4499
Practice Address - Street 1:92ND MEDICAL GROUP
Practice Address - Street 2:200 N. CHENNAULT STE 100
Practice Address - City:FAIRCHILD AFB
Practice Address - State:WA
Practice Address - Zip Code:99011
Practice Address - Country:US
Practice Address - Phone:509-247-2731
Practice Address - Fax:509-247-4499
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00002434103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P27013Medicare UPIN