Individual
MRS. AMANDA RAE LOMAX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4606 108TH ST SW, LAKEWOOD, WA 98499-4146
(253) 693-2626
Mailing address
10000B HORIZON ST, TACOMA, WA 98433-9567
(251) 404-9065
Taxonomy
Speciality
Code
Description
License number
State
374700000X
Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1512486475
TRICARE PRIME
—
Enumeration date
07/14/2021
Last updated
07/14/2021
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