Provider Demographics
NPI:1952571705
Name:WEISEL, CONSTANCE (LMP)
Entity Type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:
Last Name:WEISEL
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 1:3100 NW BUCKLIN HILL RD
Mailing Address - Street 2:STE 113
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-8358
Mailing Address - Country:US
Mailing Address - Phone:360-692-7800
Mailing Address - Fax:360-876-6083
Practice Address - Street 1:3100 NW BUCKLIN HILL RD
Practice Address - Street 2:STE 113
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8358
Practice Address - Country:US
Practice Address - Phone:360-692-7800
Practice Address - Fax:360-876-6083
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-07
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00016697174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA184228OtherWA STATE LNI