Healthcare Provider Details

I. General information

NPI: 1750427571
Provider Name (Legal Business Name): NAOMI JEAN JANOS LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 03/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1495 NW GILMAN BLVD SUITE 43
ISSAQUAH WA
98027-8975
US

IV. Provider business mailing address

1495 NW GILMAN BLVD SUITE 43
ISSAQUAH WA
98027-8975
US

V. Phone/Fax

Practice location:
  • Phone: 425-394-1200
  • Fax: 425-394-0100
Mailing address:
  • Phone: 425-394-1200
  • Fax: 425-394-0100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00017030
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: