Provider Demographics
NPI:1104067933
Name:BARNES, LAVICA JANE (ND)
Entity type:Individual
Prefix:DR
First Name:LAVICA
Middle Name:JANE
Last Name:BARNES
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21920 76TH AVE W
Mailing Address - Street 2:SUITE 203
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-7980
Mailing Address - Country:US
Mailing Address - Phone:425-776-3800
Mailing Address - Fax:425-776-3844
Practice Address - Street 1:21920 76TH AVE W
Practice Address - Street 2:SUITE 203
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7980
Practice Address - Country:US
Practice Address - Phone:425-776-3800
Practice Address - Fax:425-776-3844
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-06
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT 60024453175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath