Provider Demographics
NPI:1437422102
Name:GREENSHIELDS, ANGELA HOKE (LMP)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:HOKE
Last Name:GREENSHIELDS
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 1:1301 N CHEYENNE ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-3715
Mailing Address - Country:US
Mailing Address - Phone:253-671-1686
Mailing Address - Fax:
Practice Address - Street 1:1301 N CHEYENNE ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406-3715
Practice Address - Country:US
Practice Address - Phone:253-671-1686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-10
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60267315225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist