Provider Demographics
NPI:1043037120
Name:LIGHTHOUSE INFUSIONS, PLLC
Entity type:Organization
Organization Name:LIGHTHOUSE INFUSIONS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:REN
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA, ARNP
Authorized Official - Phone:425-835-2363
Mailing Address - Street 1:5701 NE BOTHELL WAY STE 4
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:WA
Mailing Address - Zip Code:98028-9400
Mailing Address - Country:US
Mailing Address - Phone:425-835-2363
Mailing Address - Fax:425-368-7634
Practice Address - Street 1:5701 NE BOTHELL WAY STE 4
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:WA
Practice Address - Zip Code:98028-9400
Practice Address - Country:US
Practice Address - Phone:425-835-2363
Practice Address - Fax:425-368-7634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-20
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain