Basic Information
| Provider Information | |||||||||
| NPI: | 1376618603 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | METZGER | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | ANGELA | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LMP | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | |||||||||
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| OtherMiddleName: | |||||||||
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| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 2607 BRIDGEPORT WAY W | ||||||||
| Address2: | SUITE 1-D | ||||||||
| City: | UNIVERSITY PLACE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984664700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2535646747 | ||||||||
| FaxNumber: | 2535669104 | ||||||||
| Practice Location | |||||||||
| Address1: | 2607 BRIDGEPORT WAY W | ||||||||
| Address2: | SUITE 1-D | ||||||||
| City: | UNIVERSITY PLACE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984664700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2535646747 | ||||||||
| FaxNumber: | 2535669104 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/21/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | MA00008095 | WA | Y | Other Service Providers | Specialist |
No ID Information.