NPI 1114066990

Renee Charise Probst, LMP

Practitioner Specialist University Place, WA

Practice location

Address: 4103 Bridgeport Way W STE C, University Place, WA 98466-4332
Phone: (253) 460-1824
Fax: (253) 460-1920
Mailing address: PO Box 731704, Puyallup, WA 98373-0017

Registered specialties

Specialist Primary

Other Service Providers Taxonomy 174400000X Licence MA17907 (WA)

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Registry record

NPI: 1114066990
Entity type: Individual
Sex (as registered): Female
NPI issued: 6 Feb 2007
Record last updated: 30 Jan 2012

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.