Provider Demographics
NPI:1205443918
Name:PARKER, SUSAN LUPITA (LAC, MSAS)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:LUPITA
Last Name:PARKER
Suffix:
Gender:F
Credentials:LAC, MSAS
Other - Prefix:
Other - First Name:SUSIE
Other - Middle Name:LUPITA
Other - Last Name:DENGERUD-PARKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC, MSAS
Mailing Address - Street 1:6510 208TH ST SW APT E7
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-8537
Mailing Address - Country:US
Mailing Address - Phone:206-293-2851
Mailing Address - Fax:
Practice Address - Street 1:6510 208TH ST SW APT E7
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-8537
Practice Address - Country:US
Practice Address - Phone:206-293-2851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-26
Last Update Date:2020-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61094423171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist