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General NPI Number Information
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NPI Number | 1649429317
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Entity Type | Individual
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Provider Name | ELIZABETH MARIE ALLEN-RACICOT L.M.P.
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Gender | Female
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Dates
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Enumeration Date | 09/17/2008
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Last Update Date | 09/17/2008
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Provider Practice Location Address
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Address Line | 1013 BRIDGE STREET
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City | CLARKSTON
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State | WA
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Zip | 99403
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Country | US
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Telephone | 509-751-9377
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Fax |
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Provider Business Mailing Address
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Address Line | 731 BURNELL AVE.
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City | LEWISTON
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State | ID
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Zip | 83501-4985
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Country | US
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Telephone | 208-798-3215
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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 | MA00022912
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License Number State | WA
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