Healthcare Provider Details

I. General information

NPI: 1740312073
Provider Name (Legal Business Name): AMBER LYNE SALESKY LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MRS. AMBER LYNE JENSEN

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 HWY 20
NEWPORT WA
99156
US

IV. Provider business mailing address

PO BOX 1619
NEWPORT WA
99156-1619
US

V. Phone/Fax

Practice location:
  • Phone: 509-447-2413
  • Fax:
Mailing address:
  • Phone: 509-447-2413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00016563
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: