Provider Demographics
NPI:1356541171
Name:REMAGEN, SHARON S (LMP)
Entity type:Individual
Prefix:MS
First Name:SHARON
Middle Name:S
Last Name:REMAGEN
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 1:18204 B ST E
Mailing Address - Street 2:
Mailing Address - City:SPANAWAY
Mailing Address - State:WA
Mailing Address - Zip Code:98387-8355
Mailing Address - Country:US
Mailing Address - Phone:253-846-5090
Mailing Address - Fax:253-846-5090
Practice Address - Street 1:18204 B ST E
Practice Address - Street 2:
Practice Address - City:SPANAWAY
Practice Address - State:WA
Practice Address - Zip Code:98387-8355
Practice Address - Country:US
Practice Address - Phone:253-846-5090
Practice Address - Fax:253-847-7155
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-19
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA #00008797225700000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA110433OtherLABOR AND INDUSTRIES