Individual
MS. SHANNON MICHELLE INGRUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMP
Contact information
Practice address
6210 209TH ST NE, ARLINGTON, WA 98223-4253
(360) 631-9955
Mailing address
6210 209TH ST NE, ARLINGTON, WA 98223-4253
(360) 631-9955
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA00016813
WA
Other
Enumeration date
05/03/2012
Last updated
05/03/2012
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