Provider Demographics
NPI:1891416319
Name:GUTHRIE, EBONY V (RPT CNA MAP CPT MROA)
Entity type:Individual
Prefix:
First Name:EBONY
Middle Name:V
Last Name:GUTHRIE
Suffix:
Gender:F
Credentials:RPT CNA MAP CPT MROA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7304 LAKEWOOD DR W STE 22
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-7920
Mailing Address - Country:US
Mailing Address - Phone:888-522-7443
Mailing Address - Fax:
Practice Address - Street 1:7304 LAKEWOOD DR W STE 22
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-7920
Practice Address - Country:US
Practice Address - Phone:888-522-7443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-05
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPC60569765246RM2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RM2200XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyMedical LaboratoryGroup - Multi-Specialty