Provider Demographics
NPI:1982810552
Name:MEADOR, AUDRA L (LMP)
Entity Type:Individual
Prefix:
First Name:AUDRA
Middle Name:L
Last Name:MEADOR
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 1:4744 41ST AVE SW
Mailing Address - Street 2:102
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-4570
Mailing Address - Country:US
Mailing Address - Phone:206-248-0150
Mailing Address - Fax:206-248-9306
Practice Address - Street 1:4744 41ST AVE SW
Practice Address - Street 2:102
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116-4570
Practice Address - Country:US
Practice Address - Phone:206-248-0150
Practice Address - Fax:206-248-9306
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6019960260010001OtherUBI NUMBER
WAMAOOOO9805OtherLMP