Provider Demographics
NPI:1215288352
Name:CHRISTOPHER, MARISA LAEL (LMP)
Entity type:Individual
Prefix:MS
First Name:MARISA
Middle Name:LAEL
Last Name:CHRISTOPHER
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
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Mailing Address - Street 1:152 W HENDRICKSON RD
Mailing Address - Street 2:#1
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-3162
Mailing Address - Country:US
Mailing Address - Phone:360-797-4694
Mailing Address - Fax:360-452-8079
Practice Address - Street 1:430 E LAURIDSEN BLVD
Practice Address - Street 2:#113
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-7978
Practice Address - Country:US
Practice Address - Phone:360-457-7576
Practice Address - Fax:360-452-8079
Is Sole Proprietor?:No
Enumeration Date:2012-09-28
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMA60258342174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist