Provider Demographics
NPI:1952853541
Name:PATTILLO, COLLEEN LAEL (RN LAC)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:LAEL
Last Name:PATTILLO
Suffix:
Gender:F
Credentials:RN LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1334 PUGET ST NE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-4132
Mailing Address - Country:US
Mailing Address - Phone:360-481-6498
Mailing Address - Fax:
Practice Address - Street 1:1334 PUGET ST NE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-4132
Practice Address - Country:US
Practice Address - Phone:360-481-6498
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-29
Last Update Date:2016-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60695222171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist