Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 175L00000X | Homeopath | MA00024666 | WA |
Y | 225700000X | Massage Therapist | MA00024666 | WA |
NPI | 1508046228 |
---|---|
Provider Name | Mrs. Corallee Elizabeth Weber |
First Address | Spanaway, WA 98387-4770 |
Second Address | Spanaway, WA 98387-4770 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2007 |
Last Update Date | 17/05/2019 |