Provider Demographics
NPI:1619206018
Name:KOTLARZ, NANCY ANNE (LMP)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:ANNE
Last Name:KOTLARZ
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 164TH ST SE
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98012-5947
Mailing Address - Country:US
Mailing Address - Phone:425-745-2311
Mailing Address - Fax:425-745-2988
Practice Address - Street 1:125 164TH ST SE
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98012-5947
Practice Address - Country:US
Practice Address - Phone:425-745-2311
Practice Address - Fax:425-745-2988
Is Sole Proprietor?:No
Enumeration Date:2009-12-14
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00024036174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist