Healthcare Provider Details

I. General information

NPI: 1982912960
Provider Name (Legal Business Name): BRE NICOLE JORDON LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BREANNE MONTES LMT

II. Dates (important events)

Enumeration Date: 09/23/2010
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12901 28TH PL NE STE 5
LAKE STEVENS WA
98258-9230
US

IV. Provider business mailing address

6628 77TH PL NE
MARYSVILLE WA
98270-3351
US

V. Phone/Fax

Practice location:
  • Phone: 425-535-2905
  • Fax:
Mailing address:
  • Phone: 425-535-2905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number60140091
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: