Provider Demographics
NPI:1417145285
Name:ZANDELL, CHERELL LEE (LAC)
Entity Type:Individual
Prefix:
First Name:CHERELL
Middle Name:LEE
Last Name:ZANDELL
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4940 COTTAGE LN SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-5918
Mailing Address - Country:US
Mailing Address - Phone:360-628-7390
Mailing Address - Fax:360-462-8088
Practice Address - Street 1:1635 OLYMPIC HWY N
Practice Address - Street 2:SUITE 102-A
Practice Address - City:SHELTON
Practice Address - State:WA
Practice Address - Zip Code:98584-3065
Practice Address - Country:US
Practice Address - Phone:360-462-8087
Practice Address - Fax:360-462-8088
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-05
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00003004171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist