Provider Demographics
NPI:1518093244
Name:SCANLAN, MAURA ANN (ND, LAC)
Entity Type:Individual
Prefix:DR
First Name:MAURA
Middle Name:ANN
Last Name:SCANLAN
Suffix:
Gender:F
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:24962 SE 155TH PL
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-8254
Mailing Address - Country:US
Mailing Address - Phone:425-822-0602
Mailing Address - Fax:425-822-2082
Practice Address - Street 1:12636 NE 85TH ST
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-8045
Practice Address - Country:US
Practice Address - Phone:425-822-0602
Practice Address - Fax:425-822-2082
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA721171100000X
WANT1008175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered171100000XOther Service ProvidersAcupuncturist
Not Answered175F00000XOther Service ProvidersNaturopath