Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | PY00001411 | WA |
NPI | 1093887135 |
---|---|
Provider Name | Dr. Lorna T Wilturner |
First Address | Issaquah, WA 98027-2956 |
Second Address | Issaquah, WA 98027-2956 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2006 |
Last Update Date | 27/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
170134 | VALUE OPTIONS PROV. ID (01) | |
4582387 | AETNA US HEALTHCARE ID (01) | |
WI1917 | REGENCE PIN # (01) |