Individual
MRS. CHANTEL LAIANN BASTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMP
Contact information
Practice address
3545 DELPHI RD SW, OLYMPIA, WA 98512-9345
(360) 878-0438
Mailing address
3545 DELPHI RD SW, OLYMPIA, WA 98512-9345
(360) 878-0438
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA60319175
WA
Other
Enumeration date
10/20/2012
Last updated
10/20/2012
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