Provider Demographics
NPI:1275561508
Name:WILLETT, ANANDA ELIZABETH (LMP)
Entity Type:Individual
Prefix:
First Name:ANANDA
Middle Name:ELIZABETH
Last Name:WILLETT
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 1:303 23RD AVE S APT 405
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-2379
Mailing Address - Country:US
Mailing Address - Phone:206-853-2490
Mailing Address - Fax:
Practice Address - Street 1:1032 S JACKSON ST STE 200
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-3038
Practice Address - Country:US
Practice Address - Phone:206-709-4006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00018491174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist