Healthcare Provider Details

I. General information

NPI: 1316002231
Provider Name (Legal Business Name): LEE MYRE WINJE JR. LMP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 SOUTH WASHINGTON STREET
NEWPORT WA
99156
US

IV. Provider business mailing address

PO BOX 397
NEWPORT WA
99156-0397
US

V. Phone/Fax

Practice location:
  • Phone: 509-447-2301
  • Fax:
Mailing address:
  • Phone: 509-671-7017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00021711
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: