Provider Demographics
NPI:1528358629
Name:MCBRIDE, LETTIA DANAE (LMP)
Entity type:Individual
Prefix:MRS
First Name:LETTIA
Middle Name:DANAE
Last Name:MCBRIDE
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 1:11201 ALMOTA RD
Mailing Address - Street 2:
Mailing Address - City:COLFAX
Mailing Address - State:WA
Mailing Address - Zip Code:99111-8515
Mailing Address - Country:US
Mailing Address - Phone:509-397-3190
Mailing Address - Fax:
Practice Address - Street 1:11201 ALMOTA ROAD
Practice Address - Street 2:
Practice Address - City:COLFAX
Practice Address - State:WA
Practice Address - Zip Code:99111
Practice Address - Country:US
Practice Address - Phone:509-397-3190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-11
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60110940175L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175L00000XOther Service ProvidersHomeopath