Provider Demographics
NPI:1013067008
Name:QUENZER, SHANNON LYNNE (LMP)
Entity type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:LYNNE
Last Name:QUENZER
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 1:8511 GOLD WAY
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-3424
Mailing Address - Country:US
Mailing Address - Phone:425-745-9052
Mailing Address - Fax:425-745-3372
Practice Address - Street 1:3501 SHELBY RD STE C
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98087-3599
Practice Address - Country:US
Practice Address - Phone:425-745-9052
Practice Address - Fax:425-745-3372
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00010276174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist