Provider Demographics
NPI:1053450353
Name:INGLIN, MICHELLYNN (LMP)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLYNN
Middle Name:
Last Name:INGLIN
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:MRS
Other - First Name:MICHEL
Other - Middle Name:LYNN
Other - Last Name:INGLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:18310 HWY 410 E
Mailing Address - Street 2:
Mailing Address - City:BONNEY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98391
Mailing Address - Country:US
Mailing Address - Phone:253-863-6377
Mailing Address - Fax:253-863-2052
Practice Address - Street 1:18310 HWY 410 E
Practice Address - Street 2:
Practice Address - City:BONNEY LAKE
Practice Address - State:WA
Practice Address - Zip Code:98391
Practice Address - Country:US
Practice Address - Phone:253-863-6377
Practice Address - Fax:253-863-2052
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00004014225700000X
WACL000144225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
003370OtherL AND I
8678INOtherREGENCE BLUE SHIELD