Provider Demographics
NPI:1376618603
Name:METZGER, MICHELLE ANGELA (LMP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ANGELA
Last Name:METZGER
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 1:2607 BRIDGEPORT WAY W
Mailing Address - Street 2:SUITE 1-D
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-4700
Mailing Address - Country:US
Mailing Address - Phone:253-564-6747
Mailing Address - Fax:253-566-9104
Practice Address - Street 1:2607 BRIDGEPORT WAY W
Practice Address - Street 2:SUITE 1-D
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-4700
Practice Address - Country:US
Practice Address - Phone:253-564-6747
Practice Address - Fax:253-566-9104
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00008095174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist