Provider Demographics
NPI:1073650636
Name:DUNCAN, AMY SUZANNE (CN, LMP)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:SUZANNE
Last Name:DUNCAN
Suffix:
Gender:F
Credentials:CN, LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:962 E 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-2457
Mailing Address - Country:US
Mailing Address - Phone:509-860-5611
Mailing Address - Fax:
Practice Address - Street 1:962 E 8TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-2457
Practice Address - Country:US
Practice Address - Phone:509-860-5611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANU60816855133N00000X
WAMA00022615225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0210101OtherLABOR AND INDUSTRIES