Healthcare Provider Details

I. General information

NPI: 1457631285
Provider Name (Legal Business Name): JENNIFER LYNN AUBIN LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER MALIN

II. Dates (important events)

Enumeration Date: 08/24/2011
Last Update Date: 10/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1707 3RD ST SE SUITE A
PUYALLUP WA
98372
US

IV. Provider business mailing address

17528 MERIDIAN E SUITE 207
PUYALLUP WA
98375
US

V. Phone/Fax

Practice location:
  • Phone: 253-200-2355
  • Fax: 253-200-2977
Mailing address:
  • Phone: 253-445-9030
  • Fax: 253-445-9031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number60191737
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60191737
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: