Healthcare Provider Details

I. General information

NPI: 1245386143
Provider Name (Legal Business Name): TRACY LORRAINE HONOUR L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19110 BOTHELL WAY NE SUITE 103
BOTHELL WA
98011-2970
US

IV. Provider business mailing address

19110 BOTHELL WAY NE SUITE 103
BOTHELL WA
98011-2970
US

V. Phone/Fax

Practice location:
  • Phone: 425-424-3588
  • Fax: 425-424-0818
Mailing address:
  • Phone: 425-424-3588
  • Fax: 425-424-0818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC00000526
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: