Individual
MACKENNA LUTTRELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMP
Contact information
Practice address
13025 NE FOURTH PLAIN BLVD, SUITE 102, VANCOUVER, WA 98682
(360) 718-8240
(360) 718-8241
Mailing address
956 14TH ST, WASHOUGAL, WA 98671
(360) 909-1173
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA60486817
WA
Other
Enumeration date
07/31/2014
Last updated
07/31/2014
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