Provider Demographics
NPI:1427247493
Name:LOUDENBACK, ANNA M (LMP)
Entity type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:M
Last Name:LOUDENBACK
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:M
Other - Last Name:BUSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:19655 1ST AVE S
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NORMANDY PARK
Mailing Address - State:WA
Mailing Address - Zip Code:98148-2166
Mailing Address - Country:US
Mailing Address - Phone:206-200-7042
Mailing Address - Fax:206-212-7626
Practice Address - Street 1:19655 1ST AVE S
Practice Address - Street 2:SUITE 201
Practice Address - City:NORMANDY PARK
Practice Address - State:WA
Practice Address - Zip Code:98148-2166
Practice Address - Country:US
Practice Address - Phone:206-200-7042
Practice Address - Fax:206-212-7626
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-16
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00022069174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist