Healthcare Provider Details

I. General information

NPI: 1881739597
Provider Name (Legal Business Name): JEANINE MARIE HURST LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9800 SILVERDALE WAY #107 SAME
SILVERDALE WA
98383
US

IV. Provider business mailing address

9800 SILVERDALE WAY #107 SAME
SILVERDALE WA
98383
US

V. Phone/Fax

Practice location:
  • Phone: 360-692-2273
  • Fax: 360-307-7256
Mailing address:
  • Phone: 360-692-2273
  • Fax: 360-307-7256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00005380
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: