Provider Demographics
NPI:1700101896
Name:TROTTIER, MARC DAVID (LMP)
Entity Type:Individual
Prefix:MRS
First Name:MARC
Middle Name:DAVID
Last Name:TROTTIER
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12815 CANYON RD E STE K
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-5104
Mailing Address - Country:US
Mailing Address - Phone:253-539-9411
Mailing Address - Fax:
Practice Address - Street 1:12815 CANYON RD E STE K
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-5104
Practice Address - Country:US
Practice Address - Phone:253-539-9411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-31
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60135811172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker