Provider Demographics
NPI:1093088411
Name:BELL, SHANICE (LMP)
Entity Type:Individual
Prefix:MS
First Name:SHANICE
Middle Name:
Last Name:BELL
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 1:9825 SANDIFUR PKWY
Mailing Address - Street 2:SUITE C
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-6738
Mailing Address - Country:US
Mailing Address - Phone:509-430-4640
Mailing Address - Fax:
Practice Address - Street 1:9825 SANDIFUR PKWY
Practice Address - Street 2:SUITE C
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-6738
Practice Address - Country:US
Practice Address - Phone:509-430-4640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-15
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60211162174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist