Individual
LISA JO WABINGA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA60534603
Contact information
Practice address
23639 126TH AVE SE, KENT, WA 98031-3701
(253) 631-3101
Mailing address
22907 130TH PL SE, KENT, WA 98031-3729
(253) 355-0337
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
MA60534603
WA
Other
Enumeration date
01/26/2015
Last updated
01/26/2015
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