Individual
DR. LAUREN KATHLEEN FETTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
939 CAROLINE ST, PORT ANGELES, WA 98362-3909
(360) 565-9003
(360) 565-9001
Mailing address
19020 33RD AVE W STE 210, LYNNWOOD, WA 98036-4748
(425) 563-1500
(425) 563-1374
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
71514-20
WI
2085R0202X
Diagnostic Radiology Physician
Primary
MD61038016
WA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0426796
L&I-RADIA REST OF WA
WA
01
—
0426797
L&I-SWEDISH RADIA EDMONDS
WA
01
—
0426798
L&I-RADIA KING CTY
WA
01
—
0426800
L&I-EVERGREEN RADIA
WA
01
—
0426804
L&I-SOUTH SOUND RADIOLOGY
WA
01
—
0426805
L&I-SEATTE RADIOLOGY
WA
01
—
0427056
L&I-VANCOUVER RADIOLOGY
WA
05
—
2160014
—
WA
Enumeration date
05/20/2014
Last updated
12/10/2020
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