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General NPI Number Information
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NPI Number | 1043431539
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Entity Type | Individual
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Provider Name | LAUREL A BOULDS-FISK LMP
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Gender | Female
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1755 NE 48TH ST
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City | RENTON
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State | WA
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Zip | 98056-9012
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Country | US
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Telephone | 206-679-4832
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Fax |
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Provider Business Mailing Address
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Address Line | 7030 121ST PL SE
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City | NEWCASTLE
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State | WA
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Zip | 98056-1202
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Country | US
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Telephone | 425-687-6933
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Fax | 425-687-6933
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MA00007762
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License Number State | WA
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