Provider Demographics
NPI:1184029423
Name:CORDSEN, MICHELLE (LMP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:CORDSEN
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 1:11234 171ST ST E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98374-6512
Mailing Address - Country:US
Mailing Address - Phone:253-312-6201
Mailing Address - Fax:
Practice Address - Street 1:12815 CANYON RD E
Practice Address - Street 2:SUITE K
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-5786
Practice Address - Country:US
Practice Address - Phone:253-256-4769
Practice Address - Fax:253-268-2057
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-29
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60510469174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist