Provider Demographics
NPI:1699094953
Name:BHAGWANDIN, ANNIE (LMP)
Entity type:Individual
Prefix:MRS
First Name:ANNIE
Middle Name:
Last Name:BHAGWANDIN
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 1:183 SHADY GROVE RD
Mailing Address - Street 2:
Mailing Address - City:ONALASKA
Mailing Address - State:WA
Mailing Address - Zip Code:98570-9453
Mailing Address - Country:US
Mailing Address - Phone:360-985-7033
Mailing Address - Fax:
Practice Address - Street 1:183 SHADY GROVE RD
Practice Address - Street 2:
Practice Address - City:ONALASKA
Practice Address - State:WA
Practice Address - Zip Code:98570-9453
Practice Address - Country:US
Practice Address - Phone:360-985-7033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-26
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00012157174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist