Provider Demographics
NPI:1215142757
Name:SHELTON, ANITA MARIE (LAC LMP)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:MARIE
Last Name:SHELTON
Suffix:
Gender:F
Credentials:LAC LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:729 N 77TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-4726
Mailing Address - Country:US
Mailing Address - Phone:206-782-0079
Mailing Address - Fax:
Practice Address - Street 1:729 N 77TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-4726
Practice Address - Country:US
Practice Address - Phone:206-782-0079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00000333171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist