Healthcare Provider Details

I. General information

NPI: 1053977256
Provider Name (Legal Business Name): LAUREN NICOLE HELLBERG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2019
Last Update Date: 05/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22820 N CRESCENT RD
COLBERT WA
99005-9708
US

IV. Provider business mailing address

PO BOX 283
COLBERT WA
99005-0283
US

V. Phone/Fax

Practice location:
  • Phone: 509-590-7290
  • Fax:
Mailing address:
  • Phone: 509-590-7290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: