Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225700000X | Massage Therapist | MASG-943 | ID |
Y | 225700000X | Massage Therapist | MX110072 | ID |
NPI | 1013202522 |
---|---|
Provider Name | Lauren Elaine Wek |
First Address | Boise, ID 83706-3502 |
Second Address | Boise, ID 83706-3502 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2011 |
Last Update Date | 30/12/2021 |