Healthcare Provider Details

I. General information

NPI: 1720561640
Provider Name (Legal Business Name): ANNE KATHERYN NELSON LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2018
Last Update Date: 09/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17528 MERIDIAN E STE 207
PUYALLUP WA
98375-6286
US

IV. Provider business mailing address

9901 257TH STREET CT E
GRAHAM WA
98338-8410
US

V. Phone/Fax

Practice location:
  • Phone: 253-445-9030
  • Fax:
Mailing address:
  • Phone: 507-202-6621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: