Healthcare Provider Details

I. General information

NPI: 1841406824
Provider Name (Legal Business Name): SHANNA M ARNO DOMP, DN, LMT, CYT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 01/21/2022
Certification Date: 01/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13912 NE 20TH AVE STE 105
VANCOUVER WA
98686-1401
US

IV. Provider business mailing address

13912 NE 20TH AVE STE 105
VANCOUVER WA
98686-1401
US

V. Phone/Fax

Practice location:
  • Phone: 360-694-9726
  • Fax: 360-694-9726
Mailing address:
  • Phone: 360-694-9726
  • Fax: 360-694-9726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172P00000X
TaxonomyNaprapath
License Number
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA0021648
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: