Provider Demographics
NPI:1194506105
Name:LIBOIRON-BOUIE, LYNE C (NP)
Entity type:Individual
Prefix:
First Name:LYNE
Middle Name:C
Last Name:LIBOIRON-BOUIE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12425 16TH ST E
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98372-1687
Mailing Address - Country:US
Mailing Address - Phone:512-300-7346
Mailing Address - Fax:
Practice Address - Street 1:24080 SE KENT KANGLEY RD
Practice Address - Street 2:
Practice Address - City:MAPLE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:98038-6851
Practice Address - Country:US
Practice Address - Phone:253-372-7680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-06
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61489910363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily