Individual
LARA JEAN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
126 AUBURN AVE STE 300, AUBURN, WA 98002-5082
(253) 735-0166
Mailing address
955 POWELL AVE SW, RENTON, WA 98057-2908
(425) 277-1311
(425) 277-1566
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD61073915
WA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/22/2018
Last updated
01/17/2025
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