Provider Demographics
NPI:1629139225
Name:HUNDVEN, REBECCA ANN
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:ANN
Last Name:HUNDVEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 432
Mailing Address - Street 2:
Mailing Address - City:BUCKLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98321-0432
Mailing Address - Country:US
Mailing Address - Phone:253-359-8555
Mailing Address - Fax:
Practice Address - Street 1:18209 STATE ROUTE 410 E
Practice Address - Street 2:STE 100
Practice Address - City:BONNEY LAKE
Practice Address - State:WA
Practice Address - Zip Code:98391-5146
Practice Address - Country:US
Practice Address - Phone:253-826-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA#00023259225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist