Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | AP30001943 | WA |
N | 2080P0006X | Developmental - Behavioral Pediatrician | AP30001943 | WA |
N | 363L00000X | Nurse Practitioner | AP30001943 | WA |
N | 363LC1500X | Nurse Practitioner - Community Health | AP30001943 | WA |
Y | 363LP0200X | Nurse Practitioner - Pediatrics | AP30001943 | WA |
NPI | 1255583191 |
---|---|
Provider Name | Lori Jeanne Prins |
First Address | Portland, OR 97208-3360 |
Second Address | Everett, WA 98201-4168 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/10/2008 |
Last Update Date | 23/04/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
AP30001943 | WA ST LICENSE (01) | WA |
RN00096704 | WA ST LICENSE (01) | WA |