Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA00010989 | WA |
NPI | 1003967837 |
---|---|
Provider Name | Ms. Nicole J Stumpf |
First Address | Des Moines, WA 98198-2942 |
Second Address | Des Moines, WA 98198-2942 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2007 |
Last Update Date | 08/07/2007 |