Provider Demographics
NPI:1457596710
Name:VERCUEIL, SCHEVONNE
Entity Type:Individual
Prefix:MS
First Name:SCHEVONNE
Middle Name:
Last Name:VERCUEIL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17258 REDMOND WAY
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-4403
Mailing Address - Country:US
Mailing Address - Phone:425-883-8889
Mailing Address - Fax:425-881-6854
Practice Address - Street 1:17258 REDMOND WAY
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-4403
Practice Address - Country:US
Practice Address - Phone:425-883-8889
Practice Address - Fax:425-881-6854
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-15
Last Update Date:2008-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60022791225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist