Healthcare Provider Details

I. General information

NPI: 1992059570
Provider Name (Legal Business Name): ELIZABETH ANN PRYOR L.M.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2012
Last Update Date: 11/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1223 LAKEVIEW ST
BELLINGHAM WA
98229-2515
US

IV. Provider business mailing address

1223 LAKEVIEW ST
BELLINGHAM WA
98229-2515
US

V. Phone/Fax

Practice location:
  • Phone: 360-920-4707
  • Fax:
Mailing address:
  • Phone: 360-920-4707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60304112
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: