Healthcare Provider Details

I. General information

NPI: 1316165483
Provider Name (Legal Business Name): BEVERLY JO MEISSNER L.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 AUBURN WAY N
AUBURN WA
98002-5007
US

IV. Provider business mailing address

2414 12TH AVE
MILTON WA
98354-8921
US

V. Phone/Fax

Practice location:
  • Phone: 253-931-5424
  • Fax:
Mailing address:
  • Phone: 253-431-7171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: