Provider Demographics
NPI:1184768723
Name:CONANT, MAUREEN MARIE (LAC)
Entity type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:MARIE
Last Name:CONANT
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:MISS
Other - First Name:MAUREEN
Other - Middle Name:MARIE
Other - Last Name:CAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:518 N 103RD ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-9202
Mailing Address - Country:US
Mailing Address - Phone:206-769-5180
Mailing Address - Fax:
Practice Address - Street 1:8611 35TH AVE NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-3607
Practice Address - Country:US
Practice Address - Phone:206-769-5180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00002192171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist