Individual
LORELEI RANDALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.M.P.
Contact information
Practice address
100 RUBY ST SE STE F, TUMWATER, WA 98501-6724
(360) 943-4797
(360) 709-0542
Mailing address
100 RUBY ST SE STE F, TUMWATER, WA 98501-6724
(360) 943-4797
(360) 709-0542
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA00005271
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0073016
LABOR & INDUSTRIES
WA
Enumeration date
05/11/2007
Last updated
07/08/2007
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