Provider Demographics
NPI:1922166230
Name:YORK, REBECCA ELIZABETH (LMP)
Entity Type:Individual
Prefix:MISS
First Name:REBECCA
Middle Name:ELIZABETH
Last Name:YORK
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 1:4514 NE STOUGHTON RD
Mailing Address - Street 2:
Mailing Address - City:LA CENTER
Mailing Address - State:WA
Mailing Address - Zip Code:98629-2013
Mailing Address - Country:US
Mailing Address - Phone:360-609-8923
Mailing Address - Fax:
Practice Address - Street 1:318 NE 99TH ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98665-5902
Practice Address - Country:US
Practice Address - Phone:360-609-8923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00018786174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist