Provider Demographics
NPI:1639676810
Name:HOWARD, STARLENE
Entity Type:Individual
Prefix:
First Name:STARLENE
Middle Name:
Last Name:HOWARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8911 GRAVELLY LAKE DR SW APT 106
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-3208
Mailing Address - Country:US
Mailing Address - Phone:253-279-0508
Mailing Address - Fax:
Practice Address - Street 1:8911 GRAVELLY LAKE DR SW APT 106
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-3208
Practice Address - Country:US
Practice Address - Phone:253-279-0508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-12
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty