Healthcare Provider Details

I. General information

NPI: 1063718161
Provider Name (Legal Business Name): CALLIOPE ANNE EDWARDS LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2011
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11314 4TH AVE W STE 103
EVERETT WA
98204-6926
US

IV. Provider business mailing address

515 RAINBOW PL
SNOHOMISH WA
98290-1216
US

V. Phone/Fax

Practice location:
  • Phone: 425-355-3739
  • Fax:
Mailing address:
  • Phone: 206-915-8713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60191869
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: