Healthcare Provider Details

I. General information

NPI: 1285571141
Provider Name (Legal Business Name): NANCY DOREEN HOLBROOK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 257 PMB 10960
OLYMPIA WA
98507-0257
US

IV. Provider business mailing address

PO BOX 257 PMB 10960
OLYMPIA WA
98507-0257
US

V. Phone/Fax

Practice location:
  • Phone: 253-527-9826
  • Fax:
Mailing address:
  • Phone: 253-527-9826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA61170018
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: