Provider Demographics
NPI:1295870517
Name:LUDEMANN, PATRICIA FISHER (LMP)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:FISHER
Last Name:LUDEMANN
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 1:6314 REBECCA AVE SE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98092-8018
Mailing Address - Country:US
Mailing Address - Phone:253-315-4206
Mailing Address - Fax:
Practice Address - Street 1:11713 101ST AVE E
Practice Address - Street 2:11713 101ST AVE E
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373
Practice Address - Country:US
Practice Address - Phone:253-315-4206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00021744225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0207402OtherL&I PROVIDER ACCOUNT #