Provider Demographics
NPI:1578258349
Name:WEBB, MARISA (LAC)
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:
Last Name:WEBB
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 1:24424 NE 1ST CT
Mailing Address - Street 2:
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98074-3488
Mailing Address - Country:US
Mailing Address - Phone:650-773-0348
Mailing Address - Fax:
Practice Address - Street 1:1409 140TH PL NE STE 103C
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-3963
Practice Address - Country:US
Practice Address - Phone:425-403-5164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-07
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC61413724171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist