Healthcare Provider Details

I. General information

NPI: 1194007997
Provider Name (Legal Business Name): JODIE L WANER L.M.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2011
Last Update Date: 09/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3209 E 57TH AVE STE H
SPOKANE WA
99223-7040
US

IV. Provider business mailing address

2922 N WILLOW RD
SPOKANE WA
99206-4374
US

V. Phone/Fax

Practice location:
  • Phone: 509-448-9398
  • Fax:
Mailing address:
  • Phone: 509-590-7197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number60243875
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: