Provider Demographics
NPI:1528391612
Name:OGORODNIK, NELLIE (LMP)
Entity Type:Individual
Prefix:
First Name:NELLIE
Middle Name:
Last Name:OGORODNIK
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 1:5301 EVERGREEN WAY STE B
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98203-3631
Mailing Address - Country:US
Mailing Address - Phone:425-257-1000
Mailing Address - Fax:425-353-6787
Practice Address - Street 1:5301 EVERGREEN WAY STE B
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98203-3631
Practice Address - Country:US
Practice Address - Phone:425-257-1000
Practice Address - Fax:425-353-6787
Is Sole Proprietor?:No
Enumeration Date:2009-09-08
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60105321225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist