Individual
LACEY M COLLINS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMP
Contact information
Practice address
17012 PETERSON WAY NE, POULSBO, WA 98370-8706
(360) 930-2524
Mailing address
9445 WINDSONG LOOP NE, BAINBRIDGE ISLAND, WA 98110-1346
(206) 842-6568
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA60070694
WA
Other
Enumeration date
05/05/2014
Last updated
05/05/2014
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