Healthcare Provider Details

I. General information

NPI: 1487866737
Provider Name (Legal Business Name): NANCY HUNTAMER LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 NW RICHMOND BEACH RD
SHORELINE WA
98177-3122
US

IV. Provider business mailing address

24114 107TH PL W
EDMONDS WA
98020-5241
US

V. Phone/Fax

Practice location:
  • Phone: 206-542-9488
  • Fax: 206-542-8818
Mailing address:
  • Phone: 206-779-3192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: