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General NPI Number Information
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NPI Number | 1124468624
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Entity Type | Organization
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Legal Business Name | A WOMANS PATH LLC
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Dates
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Enumeration Date | 06/28/2013
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Last Update Date | 06/28/2013
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Provider Practice Location Address
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Address Line | 5018 S STEELE ST
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City | TACOMA
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State | WA
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Zip | 98409-7134
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Country | US
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Telephone | 253-476-3154
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Fax |
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Provider Business Mailing Address
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Address Line | 5018 S STEELE ST
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City | TACOMA
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State | WA
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Zip | 98409-7134
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Country | US
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Telephone | 253-476-3154
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | ILONA MAY LORD
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Credential | LMP
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Telephone | 253-476-3154
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 603004801
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License Number State | WA
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