Provider Demographics
NPI:1699985440
Name:BONE, SHARMEL LATRICE (LMP)
Entity type:Individual
Prefix:
First Name:SHARMEL
Middle Name:LATRICE
Last Name:BONE
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 1:6416 SE 139TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97236-4592
Mailing Address - Country:US
Mailing Address - Phone:503-473-2083
Mailing Address - Fax:
Practice Address - Street 1:5000 E FOURTH PLAIN BLVD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-6584
Practice Address - Country:US
Practice Address - Phone:360-737-9665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00020024174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist