Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA60503871 | WA |
NPI | 1013388982 |
---|---|
Provider Name | Ms. Shondra Irene Hufnagel |
First Address | Auburn, WA 98002-5623 |
Second Address | Auburn, WA 98002-5623 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2015 |
Last Update Date | 16/10/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
MA60503871 | WASHINGTON DEPT. OF HEALTH MASSAGE PRACTITIONER LICENSE (01) | WA |