Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 2242 | NE |
NPI | 1003450560 |
---|---|
Provider Name | Jeanne Wacha |
First Address | Omaha, NE 68130-2007 |
Second Address | Bellevue, NE 68005-3002 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2019 |
Last Update Date | 28/10/2019 |