Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA00015568 | WA |
NPI | 1013027796 |
---|---|
Provider Name | Mercedes M Nepute |
First Address | Tacoma, WA 98403-1636 |
Second Address | University Place, WA 98466 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0172568 | L&I (01) | WA |