Provider Demographics
NPI:1780863548
Name:WESTERN, ROBIN MARIE (LMP)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:MARIE
Last Name:WESTERN
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 1:17401 135TH AVE NE STE 4
Mailing Address - Street 2:
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98072-6825
Mailing Address - Country:US
Mailing Address - Phone:425-483-2320
Mailing Address - Fax:
Practice Address - Street 1:17401 135TH AVE NE STE 4
Practice Address - Street 2:
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98072-6825
Practice Address - Country:US
Practice Address - Phone:425-483-2320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-29
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00014757174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist