Provider Demographics
NPI:1093224180
Name:LOPEZ, SUNSHINE PATTERSON (LMT)
Entity Type:Individual
Prefix:
First Name:SUNSHINE
Middle Name:PATTERSON
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:RYAN
Other - Middle Name:NICHOLE
Other - Last Name:PATTERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2510 CRESTLINE DR NW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-4328
Mailing Address - Country:US
Mailing Address - Phone:808-388-5148
Mailing Address - Fax:
Practice Address - Street 1:147 ROGERS ST NW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-5343
Practice Address - Country:US
Practice Address - Phone:808-447-9129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-21
Last Update Date:2017-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374J00000X
WAMA60764955225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No374J00000XNursing Service Related ProvidersDoula