Healthcare Provider Details

I. General information

NPI: 1306138417
Provider Name (Legal Business Name): DAWN JOY EDGAR LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2011
Last Update Date: 05/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5204 NE 131ST AVE
VANCOUVER WA
98682-2116
US

IV. Provider business mailing address

5204 NE 131ST AVE
VANCOUVER WA
98682-2116
US

V. Phone/Fax

Practice location:
  • Phone: 503-743-7228
  • Fax:
Mailing address:
  • Phone: 503-743-7228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA 60217498
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License NumberMA 60217498
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: