Provider Demographics
NPI:1457678567
Name:QUAMMEN, INGA JO (LMP)
Entity Type:Individual
Prefix:MISS
First Name:INGA
Middle Name:JO
Last Name:QUAMMEN
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8530 W GAGE BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-7162
Mailing Address - Country:US
Mailing Address - Phone:509-380-1562
Mailing Address - Fax:509-737-1406
Practice Address - Street 1:8530 W GAGE BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-7162
Practice Address - Country:US
Practice Address - Phone:509-380-1562
Practice Address - Fax:509-737-1406
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-28
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 00024807225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist