Provider Demographics
NPI:1013388982
Name:HUFNAGEL, SHONDRA IRENE
Entity Type:Individual
Prefix:MS
First Name:SHONDRA
Middle Name:IRENE
Last Name:HUFNAGEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:949 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-5623
Mailing Address - Country:US
Mailing Address - Phone:253-833-2999
Mailing Address - Fax:253-833-1331
Practice Address - Street 1:949 E MAIN ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-5623
Practice Address - Country:US
Practice Address - Phone:253-833-2999
Practice Address - Fax:253-833-1331
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-16
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60503871225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA60503871OtherWASHINGTON DEPT. OF HEALTH MASSAGE PRACTITIONER LICENSE