Individual
TERESA C ALLEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMP
Contact information
Practice address
3211 W WAPATO DR UNIT 61, MOSES LAKE, WA 98837-4507
(509) 361-3969
Mailing address
PO BOX 2302, MOSES LAKE, WA 98837-0702
(509) 361-3969
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA00022911
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MA00022911
WASHINGTON STATE HEALTH DEPARTMENT
WA
Enumeration date
02/15/2010
Last updated
08/08/2014
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