Provider Demographics
NPI:1023334760
Name:CIOLLI, KARISA MARIE (LMP)
Entity type:Individual
Prefix:MISS
First Name:KARISA
Middle Name:MARIE
Last Name:CIOLLI
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 1:1211 GEORGE WASHINGTON WAY
Mailing Address - Street 2:APT 48
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-3444
Mailing Address - Country:US
Mailing Address - Phone:509-572-7927
Mailing Address - Fax:
Practice Address - Street 1:712 SWIFT BLVD
Practice Address - Street 2:SUITE 3B
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3578
Practice Address - Country:US
Practice Address - Phone:509-946-4422
Practice Address - Fax:509-946-4422
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-19
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA13071175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath