Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA60397425 | WA |
NPI | 1013300219 |
---|---|
Provider Name | Lauren Wallenfang |
First Address | Sequim, WA 98382-4322 |
Second Address | Sequim, WA 98382-5097 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/03/2015 |
Last Update Date | 29/03/2019 |