Provider Demographics
NPI:1619287604
Name:BAKEWELL, DANETTE M (LMP)
Entity Type:Individual
Prefix:MRS
First Name:DANETTE
Middle Name:M
Last Name:BAKEWELL
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 1:312 COLUMBIA ST NW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-1031
Mailing Address - Country:US
Mailing Address - Phone:360-357-1390
Mailing Address - Fax:360-357-1391
Practice Address - Street 1:312 COLUMBIA ST NW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-1031
Practice Address - Country:US
Practice Address - Phone:360-357-1390
Practice Address - Fax:360-357-1391
Is Sole Proprietor?:No
Enumeration Date:2010-10-08
Last Update Date:2011-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00024055174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist