Provider Demographics
NPI:1538378419
Name:FOSS, ARTISANNE W (LAC, LMP)
Entity type:Individual
Prefix:
First Name:ARTISANNE
Middle Name:W
Last Name:FOSS
Suffix:
Gender:F
Credentials:LAC, LMP
Other - Prefix:
Other - First Name:SUE
Other - Middle Name:W
Other - Last Name:FOSS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC, LMP
Mailing Address - Street 1:27420 SE GREEN RIVER GORGE RD
Mailing Address - Street 2:
Mailing Address - City:BLACK DIAMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98010-7616
Mailing Address - Country:US
Mailing Address - Phone:425-557-9519
Mailing Address - Fax:425-557-0595
Practice Address - Street 1:120 1ST AVE NW
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-3228
Practice Address - Country:US
Practice Address - Phone:425-557-9519
Practice Address - Fax:425-557-0595
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC0000267171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist