Provider Demographics
NPI:1720448574
Name:SUNDIN, CARMEN
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:
Last Name:SUNDIN
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:PO BOX 194
Mailing Address - Street 2:
Mailing Address - City:VADER
Mailing Address - State:WA
Mailing Address - Zip Code:98593-0194
Mailing Address - Country:US
Mailing Address - Phone:360-295-0906
Mailing Address - Fax:360-295-0907
Practice Address - Street 1:801 B STREET
Practice Address - Street 2:
Practice Address - City:VADER
Practice Address - State:WA
Practice Address - Zip Code:98593-0194
Practice Address - Country:US
Practice Address - Phone:360-295-0906
Practice Address - Fax:360-295-0907
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-07
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAMBV.ES.60271398146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic