MEDICARE: MISTI JEAN ECK LMP.,CPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	MA22300	WA

General Provider Information

NPI Number	:	1336278845
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISTI JEAN ECK LMP.,CPT

Provider Business Mailing Address
First Line	:	95 N SUMMIT RD
Second Line	:
City	:	MCCLEARY
State	:	WA
Zip	:	98557-9719
Country	:	US
Telephone Number	:	360-259-1369
Fax Number	:

Provider Business Practice Location Address
First Line	:	95 N SUMMIT RD
Second Line	:
City	:	MCCLEARY
State	:	WA
Zip	:	98557-9719
Country	:	US
Telephone Number	:	360-259-1369
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/02/2007
Last Update Date	:	07/08/2007

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