Provider Demographics
NPI:1598234973
Name:TOLLIVER-WARREN, LAWLESS HILLETHEO
Entity Type:Individual
Prefix:
First Name:LAWLESS
Middle Name:HILLETHEO
Last Name:TOLLIVER-WARREN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LAWLESS
Other - Middle Name:HILLETHEO
Other - Last Name:TOLLIVER-PEREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:118 E 8TH ST
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-6129
Mailing Address - Country:US
Mailing Address - Phone:360-457-0431
Mailing Address - Fax:360-457-5699
Practice Address - Street 1:118 E 8TH ST
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-6129
Practice Address - Country:US
Practice Address - Phone:360-457-0431
Practice Address - Fax:360-457-5699
Is Sole Proprietor?:No
Enumeration Date:2018-11-15
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist