Provider Demographics
NPI:1669659074
Name:LOLLEY, KARA HUNGATE (ND)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:HUNGATE
Last Name:LOLLEY
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 S 12TH AVE STE 11
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-3141
Mailing Address - Country:US
Mailing Address - Phone:509-469-2483
Mailing Address - Fax:
Practice Address - Street 1:307 S 12TH AVE STE 11
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3141
Practice Address - Country:US
Practice Address - Phone:509-469-2483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-28
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00002264171100000X
WANT00001087175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist