Provider Demographics
NPI:1740555176
Name:YARBROUGH, ALEXANDREA DAWN (LMP)
Entity type:Individual
Prefix:MS
First Name:ALEXANDREA
Middle Name:DAWN
Last Name:YARBROUGH
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:PO BOX 5924
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98046-5924
Mailing Address - Country:US
Mailing Address - Phone:360-202-4042
Mailing Address - Fax:
Practice Address - Street 1:19720 68TH AVE W STE B
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-4568
Practice Address - Country:US
Practice Address - Phone:425-673-4161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-19
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60269993174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist