Provider Demographics
NPI:1750426136
Name:PANNELL, SHARON ROSE (LMP)
Entity type:Individual
Prefix:MS
First Name:SHARON
Middle Name:ROSE
Last Name:PANNELL
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 1:22142 SE 237TH
Mailing Address - Street 2:SUITE 7 SHARON ROSE PANNELL
Mailing Address - City:MAPLE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98038
Mailing Address - Country:US
Mailing Address - Phone:425-413-8184
Mailing Address - Fax:
Practice Address - Street 1:22142 SE 237TH
Practice Address - Street 2:SUITE 7 SHARON ROSE PANNELL
Practice Address - City:MAPLE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:98038
Practice Address - Country:US
Practice Address - Phone:425-413-8184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA3521225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist