Provider Demographics
NPI:1477821569
Name:ISHMAEL, JUJU ANNA (LMP)
Entity Type:Individual
Prefix:
First Name:JUJU
Middle Name:ANNA
Last Name:ISHMAEL
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 1:334 N 71ST ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-5020
Mailing Address - Country:US
Mailing Address - Phone:206-227-5244
Mailing Address - Fax:
Practice Address - Street 1:334 N 71ST ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-5020
Practice Address - Country:US
Practice Address - Phone:206-227-5244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-05
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00013723225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist