Individual
TRISTA RAWLINGS LAWRENCE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMP
Contact information
Practice address
477 PEACE PORTAL DRIVE, SUITE 5B, BLAINE, WA 98230
(360) 332-8000
(360) 371-4085
Mailing address
PO BOX 2647, BLAINE, WA 98231
(360) 332-8000
(360) 371-4085
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA00012980
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1236RA
ADDITIONAL RBS PROVIDER N
WA
01
—
140125
L&I PROVIDER #
WA
01
—
1714RA
RBS PROVIDER NUMBER
WA
Enumeration date
05/01/2007
Last updated
07/08/2007
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