Provider Demographics
NPI:1700282787
Name:LAGUIO, TRIFENIA
Entity Type:Individual
Prefix:
First Name:TRIFENIA
Middle Name:
Last Name:LAGUIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:774 N 204TH ST
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-3113
Mailing Address - Country:US
Mailing Address - Phone:206-542-3508
Mailing Address - Fax:206-542-5145
Practice Address - Street 1:774 N 204TH ST
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-3113
Practice Address - Country:US
Practice Address - Phone:206-542-3508
Practice Address - Fax:206-542-5145
Is Sole Proprietor?:No
Enumeration Date:2014-11-18
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANC10022687376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA157267Medicaid