Individual
MISS SHANNON LARAE CARPENTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMP
Contact information
Practice address
518 S TOBIN ST, RENTON, WA 98055-1303
(206) 715-9027
Mailing address
2614 M ST SE, AUBURN, WA 98002-7765
(206) 715-9027
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA00019843
WA
Other
Enumeration date
01/26/2007
Last updated
07/08/2007
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