Provider Demographics
NPI:1609055805
Name:WILLIAMS, LORENA MARIE (LMP)
Entity Type:Individual
Prefix:
First Name:LORENA
Middle Name:MARIE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:LORENA
Other - Middle Name:MARIE
Other - Last Name:STOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1735 E BROAD AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99207-4208
Mailing Address - Country:US
Mailing Address - Phone:509-487-1276
Mailing Address - Fax:509-327-2198
Practice Address - Street 1:515 W FRANCIS AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-6413
Practice Address - Country:US
Practice Address - Phone:509-326-5762
Practice Address - Fax:509-327-2198
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-24
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00024455172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker