Provider Demographics
NPI:1649492836
Name:AVERBECK, CARA MICHELLE (LMP)
Entity type:Individual
Prefix:
First Name:CARA
Middle Name:MICHELLE
Last Name:AVERBECK
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 1:866 S. ALDER ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98233
Mailing Address - Country:US
Mailing Address - Phone:360-770-4061
Mailing Address - Fax:360-707-5555
Practice Address - Street 1:866 S. ALDER ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98233
Practice Address - Country:US
Practice Address - Phone:360-770-4061
Practice Address - Fax:360-707-5555
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00022196174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist