Provider Demographics
NPI:1336533504
Name:SHTATNIK, OXANNA (LMP)
Entity Type:Individual
Prefix:
First Name:OXANNA
Middle Name:
Last Name:SHTATNIK
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:PO BOX 491
Mailing Address - Street 2:
Mailing Address - City:LYNDEN
Mailing Address - State:WA
Mailing Address - Zip Code:98264-0491
Mailing Address - Country:US
Mailing Address - Phone:360-927-4265
Mailing Address - Fax:
Practice Address - Street 1:6922 HANNEGAN RD # 2
Practice Address - Street 2:
Practice Address - City:LYNDEN
Practice Address - State:WA
Practice Address - Zip Code:98264-9620
Practice Address - Country:US
Practice Address - Phone:360-927-4265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-25
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60326542225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist