Provider Demographics
NPI:1699097600
Name:FONTAINE, SHAUNA C (LMP)
Entity type:Individual
Prefix:MRS
First Name:SHAUNA
Middle Name:C
Last Name:FONTAINE
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 1:3507 NE SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98056-3330
Mailing Address - Country:US
Mailing Address - Phone:425-277-0222
Mailing Address - Fax:425-277-0246
Practice Address - Street 1:3507 NE SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98056-3330
Practice Address - Country:US
Practice Address - Phone:425-277-0222
Practice Address - Fax:425-277-0246
Is Sole Proprietor?:No
Enumeration Date:2010-02-17
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00024898225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist