Individual
RENEE CHARISE PROBST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMP
Contact information
Practice address
4103 BRIDGEPORT WAY W STE C, UNIVERSITY PLACE, WA 98466-4332
(253) 460-1824
(253) 460-1920
Mailing address
PO BOX 731704, PUYALLUP, WA 98373-0017
(253) 861-9983
(253) 460-1920
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA17907
WA
Other
Enumeration date
02/06/2007
Last updated
01/30/2012
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