Provider Demographics
NPI:1104250794
Name:AGAFONOV, NADIA N (LMP)
Entity type:Individual
Prefix:
First Name:NADIA
Middle Name:N
Last Name:AGAFONOV
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:NADIA
Other - Middle Name:N
Other - Last Name:SAVCHUK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:22577 116TH PL SE
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98031-3971
Mailing Address - Country:US
Mailing Address - Phone:206-697-9139
Mailing Address - Fax:
Practice Address - Street 1:22577 116TH PL SE
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98031-3971
Practice Address - Country:US
Practice Address - Phone:206-697-9139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-30
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60397104225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist