Provider Demographics
NPI:1831559285
Name:LUNDQUIST, ASIA R (LMT)
Entity type:Individual
Prefix:
First Name:ASIA
Middle Name:R
Last Name:LUNDQUIST
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9403 121ST ST SW
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98498-1207
Mailing Address - Country:US
Mailing Address - Phone:253-208-9012
Mailing Address - Fax:
Practice Address - Street 1:8520 STEILACOOM BLVD SW STE 101
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98498-4773
Practice Address - Country:US
Practice Address - Phone:253-507-7564
Practice Address - Fax:253-625-7241
Is Sole Proprietor?:No
Enumeration Date:2016-02-28
Last Update Date:2019-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60581530174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist