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General NPI Number Information
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NPI Number | 1619343191
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Entity Type | Individual
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Provider Name | LAUREN CHRISTINE DIFOLCO
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Gender | Female
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Dates
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Enumeration Date | 08/19/2015
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Last Update Date | 08/19/2015
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Provider Practice Location Address
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Address Line | 10920 199TH AVE. CT. E. BONNEY LAKE HS,
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City | BONNEY LAKE
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State | WA
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Zip | 98391
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Country | US
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Telephone | 253-891-5700
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Fax |
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Provider Business Mailing Address
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Address Line | 1221 MOTTMAN RD SW APT D203
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City | TUMWATER
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State | WA
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Zip | 98512-6391
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Country | US
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Telephone | 720-425-4641
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Fax |
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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 | 516288H
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License Number State | WA
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