Healthcare Provider Details

I. General information

NPI: 1093825184
Provider Name (Legal Business Name): MARY KATHERINE BOLINGER LMP, L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 WESTERN AVE SUITE 306A
SEATTLE WA
98104-3605
US

IV. Provider business mailing address

2521 E HELEN ST
SEATTLE WA
98112-3617
US

V. Phone/Fax

Practice location:
  • Phone: 206-774-1663
  • Fax: 206-260-7421
Mailing address:
  • Phone: 206-774-1663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC00002765
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: