Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225700000X | Massage Therapist | MA60387889 | WA |
NPI | 1003351909 |
---|---|
Provider Name | Serena Emerson |
First Address | Lummi Island, WA 98262-8631 |
Second Address | Lummi Island, WA 98262-8631 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/12/2016 |
Last Update Date | 16/12/2019 |