Provider Demographics
NPI:1437563442
Name:MARINO, LAUREN (LMP)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:MARINO
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 ELECTRIC AVE APT 328
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98229-4563
Mailing Address - Country:US
Mailing Address - Phone:503-577-1424
Mailing Address - Fax:
Practice Address - Street 1:2100 ELECTRIC AVE APT 328
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98229-4563
Practice Address - Country:US
Practice Address - Phone:503-577-1424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-17
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60327275225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist