Provider Demographics
NPI:1033444336
Name:MCPHERSON WIDEN, SHARON LEE (LMP)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:LEE
Last Name:MCPHERSON WIDEN
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23369 PRINGLE STREET
Mailing Address - Street 2:
Mailing Address - City:CLEARLAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98235-0052
Mailing Address - Country:US
Mailing Address - Phone:360-708-3246
Mailing Address - Fax:
Practice Address - Street 1:23369 PRINGLE STREET
Practice Address - Street 2:POB 52
Practice Address - City:CLEARLAKE
Practice Address - State:WA
Practice Address - Zip Code:98235-0052
Practice Address - Country:US
Practice Address - Phone:360-854-9765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-05
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60102554225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist