Provider Demographics
NPI:1063628824
Name:LINES, KATIA LYNETTE (LMP)
Entity type:Individual
Prefix:MRS
First Name:KATIA
Middle Name:LYNETTE
Last Name:LINES
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:MRS
Other - First Name:KATIA
Other - Middle Name:LYNETTE
Other - Last Name:LINES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMP
Mailing Address - Street 1:11615 45TH DR SE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-9158
Mailing Address - Country:US
Mailing Address - Phone:206-730-6197
Mailing Address - Fax:
Practice Address - Street 1:11615 45TH DR SE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-9158
Practice Address - Country:US
Practice Address - Phone:206-730-6197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00018919174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist