Provider Demographics
NPI:1609161223
Name:FLACK, NOREEN PAULA (LMP)
Entity Type:Individual
Prefix:
First Name:NOREEN
Middle Name:PAULA
Last Name:FLACK
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 1:5424 BALLARD AVE NW
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-4046
Mailing Address - Country:US
Mailing Address - Phone:206-789-1693
Mailing Address - Fax:
Practice Address - Street 1:5424 BALLARD AVE NW
Practice Address - Street 2:SUITE 200
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-4046
Practice Address - Country:US
Practice Address - Phone:206-789-1693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-11
Last Update Date:2011-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00006855173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist