Provider Demographics
NPI:1962627703
Name:WILBER, ROBYN E (LAC)
Entity Type:Individual
Prefix:
First Name:ROBYN
Middle Name:E
Last Name:WILBER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18200 11TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98155-3728
Mailing Address - Country:US
Mailing Address - Phone:206-310-2123
Mailing Address - Fax:
Practice Address - Street 1:1207 N 200TH ST STE 107
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-3200
Practice Address - Country:US
Practice Address - Phone:206-533-9999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00002616171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist