Provider Demographics
NPI:1548550197
Name:AMBURGY, LAWRENCE RODNEY (LMP)
Entity type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:RODNEY
Last Name:AMBURGY
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1828 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-2153
Mailing Address - Country:US
Mailing Address - Phone:425-355-8834
Mailing Address - Fax:
Practice Address - Street 1:627 5TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:MUKILTEO
Practice Address - State:WA
Practice Address - Zip Code:98275-1580
Practice Address - Country:US
Practice Address - Phone:425-355-8834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-17
Last Update Date:2011-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 00011279174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist